Healthcare Provider Details

I. General information

NPI: 1407438575
Provider Name (Legal Business Name): ANDREA LYNN JOHNSON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 ADAMS AVE
KNOXVILLE TN
37917-6908
US

IV. Provider business mailing address

2305 ADAMS AVE
KNOXVILLE TN
37917-6908
US

V. Phone/Fax

Practice location:
  • Phone: 865-256-6307
  • Fax:
Mailing address:
  • Phone: 865-256-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number44D2216102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: