Healthcare Provider Details

I. General information

NPI: 1568010528
Provider Name (Legal Business Name): ABIGAIL OVERHOLT NIEMAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 510
KNOXVILLE TN
37916-2225
US

IV. Provider business mailing address

4320B TAZEWELL PIKE
KNOXVILLE TN
37918-2703
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax:
Mailing address:
  • Phone: 865-237-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number230985
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: