Healthcare Provider Details

I. General information

NPI: 1710642244
Provider Name (Legal Business Name): JENNIFER R. ESTES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LAUREL AVE. STE. 206
KNOXVILLE TN
37916
US

IV. Provider business mailing address

2001 LAUREL AVE. STE. 206
KNOXVILLE TN
37916
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-3131
  • Fax: 865-212-6323
Mailing address:
  • Phone: 865-524-3131
  • Fax: 865-212-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5049
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: