Healthcare Provider Details

I. General information

NPI: 1417589029
Provider Name (Legal Business Name): CATHERINE LEWIS WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY STE C270
KNOXVILLE TN
37920-1537
US

IV. Provider business mailing address

124 GILBERT LN
KNOXVILLE TN
37920-3617
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-4658
  • Fax: 865-251-4659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number215612
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number27288
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: