Healthcare Provider Details

I. General information

NPI: 1225899610
Provider Name (Legal Business Name): REILLY MARIE MUNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 OLD WEISGARBER RD STE 200
KNOXVILLE TN
37909-1341
US

IV. Provider business mailing address

6016 BROOKVALE LN STE 200
KNOXVILLE TN
37919-4092
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-5800
  • Fax: 865-934-5801
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5939
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5939
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: