Healthcare Provider Details

I. General information

NPI: 1144725102
Provider Name (Legal Business Name): KRISTIN ARIANA O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY STE 570
KNOXVILLE TN
37920-1588
US

IV. Provider business mailing address

PO BOX 415000-MSC8151
NASHVILLE TN
37241-8151
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-6500
  • Fax: 865-305-6509
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: