Healthcare Provider Details

I. General information

NPI: 1023805264
Provider Name (Legal Business Name): MOLLIE MARIE CHRISTINE PLOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9737 COGDILL RD
KNOXVILLE TN
37932-3322
US

IV. Provider business mailing address

W8406 SCHOOL RD
HORTONVILLE WI
54944-9228
US

V. Phone/Fax

Practice location:
  • Phone: 865-338-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: