Healthcare Provider Details

I. General information

NPI: 1598509713
Provider Name (Legal Business Name): JODI GRAHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 WEBB SCHOOL LN
KNOXVILLE TN
37923-3399
US

IV. Provider business mailing address

9800 WEBB SCHOOL LN
KNOXVILLE TN
37923-3399
US

V. Phone/Fax

Practice location:
  • Phone: 865-466-8557
  • Fax:
Mailing address:
  • Phone: 865-466-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number0000146303
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: