Healthcare Provider Details

I. General information

NPI: 1124096136
Provider Name (Legal Business Name): JESSICA IVEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 PARK WEST BLVD STE 200
KNOXVILLE TN
37923-4317
US

IV. Provider business mailing address

PO BOX 26194
BELFAST ME
04915-2012
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-4600
  • Fax: 833-908-2096
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-450-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number034822
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34822
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: