Healthcare Provider Details

I. General information

NPI: 1669237962
Provider Name (Legal Business Name): ANDRE DAVIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 SILICON VALLEY WAY
KNOXVILLE TN
37931-4288
US

IV. Provider business mailing address

2745 SILICON VALLEY WAY
KNOXVILLE TN
37931-4288
US

V. Phone/Fax

Practice location:
  • Phone: 865-696-9196
  • Fax:
Mailing address:
  • Phone: 865-696-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number247243
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: