Healthcare Provider Details

I. General information

NPI: 1407096035
Provider Name (Legal Business Name): SHARON KECK DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 EMERALD AVE SUITE 806
KNOXVILLE TN
37917-4502
US

IV. Provider business mailing address

939 EMERALD AVE SUITE 806
KNOXVILLE TN
37917-4502
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-8231
  • Fax: 865-637-0366
Mailing address:
  • Phone: 865-637-8231
  • Fax: 865-637-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number45130
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5421
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: