Healthcare Provider Details

I. General information

NPI: 1801950399
Provider Name (Legal Business Name): SAMANTHA R PETTY APN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 KINGSTON PIKE SUITE 100
KNOXVILLE TN
37934-3838
US

IV. Provider business mailing address

PO BOX 21867
CHATTANOOGA TN
37424-0867
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-0500
  • Fax: 423-899-2411
Mailing address:
  • Phone: 423-899-0500
  • Fax: 423-899-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000039380
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000005270
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: