Healthcare Provider Details

I. General information

NPI: 1437814753
Provider Name (Legal Business Name): ALLISON ELAINE BREEDEN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON ELAINE HERRON

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1477 DOUBLE D DR
SEVIERVILLE TN
37876-0289
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9607
  • Fax:
Mailing address:
  • Phone: 865-705-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number193995
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: