Healthcare Provider Details

I. General information

NPI: 1245731231
Provider Name (Legal Business Name): ROOTS & WINGS MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 SUTHERLAND AVE
KNOXVILLE TN
37919-4338
US

IV. Provider business mailing address

3715 SUTHERLAND AVE
KNOXVILLE TN
37919-4338
US

V. Phone/Fax

Practice location:
  • Phone: 865-226-9344
  • Fax: 865-851-8191
Mailing address:
  • Phone: 865-226-9344
  • Fax: 865-851-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REBEKAH MUSTALESKI
Title or Position: MIDWIFE
Credential: CPM
Phone: 865-300-2997