Healthcare Provider Details

I. General information

NPI: 1366979122
Provider Name (Legal Business Name): OPTIMAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8874 KINGSTON PIKE SUITE 202
KNOXVILLE TN
37923-5010
US

IV. Provider business mailing address

217 N CALDERWOOD ST
ALCOA TN
37701-2111
US

V. Phone/Fax

Practice location:
  • Phone: 865-691-9055
  • Fax: 865-531-9018
Mailing address:
  • Phone: 865-983-8330
  • Fax: 865-862-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHY A HUMPHREY
Title or Position: CORPORATE COMPLIANCE OFFICER
Credential:
Phone: 865-691-9055