Healthcare Provider Details

I. General information

NPI: 1053745828
Provider Name (Legal Business Name): BARBARA ANN MINK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CITICO ST
KNOXVILLE TN
37921-5811
US

IV. Provider business mailing address

412 CITICO ST
KNOXVILLE TN
37921-5811
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-0661
  • Fax:
Mailing address:
  • Phone: 865-522-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0000080780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: