Healthcare Provider Details

I. General information

NPI: 1548392566
Provider Name (Legal Business Name): GLENDA S MAYFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10263 KINGSTON PIKE
KNOXVILLE TN
37922
US

IV. Provider business mailing address

DEPARTMENT 888182
KNOXVILLE TN
37995-8182
US

V. Phone/Fax

Practice location:
  • Phone: 865-670-9231
  • Fax: 865-531-3460
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN30508
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: