Healthcare Provider Details

I. General information

NPI: 1699230904
Provider Name (Legal Business Name): DANIELLE WING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 PAPERMILL DR
KNOXVILLE TN
37919-4858
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-8229
  • Fax: 865-212-0163
Mailing address:
  • Phone: 865-306-5700
  • Fax: 865-584-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4591
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4591
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: