Healthcare Provider Details

I. General information

NPI: 1053558783
Provider Name (Legal Business Name): REBECCA D STYLES MICROPIGMENTATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR SUITE 310
KNOXVILLE TN
37934-1979
US

IV. Provider business mailing address

10810 PARKSIDE DR SUITE 310
KNOXVILLE TN
37934-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-6210
  • Fax: 865-218-6211
Mailing address:
  • Phone: 865-218-6210
  • Fax: 865-218-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5819080
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberELE0000000163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: