Healthcare Provider Details

I. General information

NPI: 1134308646
Provider Name (Legal Business Name): JENNIFER LYNN ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN ANDERSON M.D.

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 W GOVERNOR JOHN SEVIER HWY
KNOXVILLE TN
37920-5552
US

IV. Provider business mailing address

PO BOX 4578
SEVIERVILLE TN
37864-4578
US

V. Phone/Fax

Practice location:
  • Phone: 865-298-3558
  • Fax:
Mailing address:
  • Phone: 865-365-4233
  • Fax: 865-365-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101268169
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number43185
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43185
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: