Healthcare Provider Details

I. General information

NPI: 1366338873
Provider Name (Legal Business Name): SAMANTHA WALESKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

2113 HARMONY LN
MARYVILLE TN
37801-2422
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9000
  • Fax:
Mailing address:
  • Phone: 317-979-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0000239632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: