Healthcare Provider Details

I. General information

NPI: 1568103000
Provider Name (Legal Business Name): JENNIFER MCMAHAN MCCAMPBELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 KINGSTON PIKE STE 8W
KNOXVILLE TN
37919-4906
US

IV. Provider business mailing address

8762 HOLLINGSFIELD DR
KNOXVILLE TN
37922-9429
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8630
  • Fax:
Mailing address:
  • Phone: 865-919-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2726
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: