Healthcare Provider Details

I. General information

NPI: 1275351025
Provider Name (Legal Business Name): SIERRA DESIREE ECCLES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 W 5TH AVE
KNOXVILLE TN
37917-7109
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2104
  • Fax: 865-525-2212
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number102593
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: