Healthcare Provider Details

I. General information

NPI: 1851650865
Provider Name (Legal Business Name): KENNETH ROBERT JOHNSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 PAPERMILL DR STE 200
KNOXVILLE TN
37909-1907
US

IV. Provider business mailing address

4707 PAPERMILL DR STE 200
KNOXVILLE TN
37909-1907
US

V. Phone/Fax

Practice location:
  • Phone: 865-602-7983
  • Fax: 865-602-7984
Mailing address:
  • Phone: 865-602-7983
  • Fax: 865-602-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51150
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51150
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number51150
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: