Healthcare Provider Details

I. General information

NPI: 1932523487
Provider Name (Legal Business Name): ANDRA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDRA SINGLETON

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E WEISGARBER RD STE 180
KNOXVILLE TN
37909-2672
US

IV. Provider business mailing address

1225 E WEISGARBER RD STE 180
KNOXVILLE TN
37909-2672
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-5558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4915
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: