Healthcare Provider Details

I. General information

NPI: 1265889737
Provider Name (Legal Business Name): MEREDITH BOGOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 05/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

5621 BURBURY LN
KNOXVILLE TN
37921-3868
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number182610
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: