Healthcare Provider Details

I. General information

NPI: 1215810593
Provider Name (Legal Business Name): LE ROY EVANS III BSN, RN, TCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

IV. Provider business mailing address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 615-447-8337
  • Fax:
Mailing address:
  • Phone: 615-447-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number198030
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number198030
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number198030
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number198030
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198030
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: