Healthcare Provider Details

I. General information

NPI: 1699760199
Provider Name (Legal Business Name): MELANIE COLEEN MIXON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2706
US

IV. Provider business mailing address

6701 BAUM DR SUITE140
KNOXVILLE TN
37919-7360
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8588
  • Fax: 865-584-3364
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN129000
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8101
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: