Healthcare Provider Details

I. General information

NPI: 1124901582
Provider Name (Legal Business Name): RENEE MICHELE DUDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 SUTHERLAND AVE
KNOXVILLE TN
37919-4338
US

IV. Provider business mailing address

1915 EDGEWOOD AVE
KNOXVILLE TN
37917-3819
US

V. Phone/Fax

Practice location:
  • Phone: 865-226-9344
  • Fax:
Mailing address:
  • Phone: 865-456-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number164
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: