Healthcare Provider Details

I. General information

NPI: 1912496548
Provider Name (Legal Business Name): ANDREA MICHELLE CUTSHAW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 LAZY RIVER DR
KNOXVILLE TN
37931-3261
US

IV. Provider business mailing address

3022 LAZY RIVER DR
KNOXVILLE TN
37931-3261
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-4704
  • Fax:
Mailing address:
  • Phone: 865-320-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number9140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: