Healthcare Provider Details

I. General information

NPI: 1477979995
Provider Name (Legal Business Name): NICHOL OOTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

103 HARLAND CT
OAK RIDGE TN
37830-7904
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5354
  • Fax:
Mailing address:
  • Phone: 865-806-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number3585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: