Healthcare Provider Details

I. General information

NPI: 1053862474
Provider Name (Legal Business Name): SEGUIN WARWICK BEUERLEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEGUIN LEE WARWICK PA-C

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3330
US

IV. Provider business mailing address

9711 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3330
US

V. Phone/Fax

Practice location:
  • Phone: 865-373-5050
  • Fax: 865-373-5051
Mailing address:
  • Phone: 865-373-5050
  • Fax: 865-373-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1194
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07287
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9113993
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3141
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: