Healthcare Provider Details

I. General information

NPI: 1265746465
Provider Name (Legal Business Name): TENNESSEE PREFERRED MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 KINGSTON PIKE
KNOXVILLE TN
37919-4022
US

IV. Provider business mailing address

6221 KINGSTON PIKE
KNOXVILLE TN
37919-4022
US

V. Phone/Fax

Practice location:
  • Phone: 865-450-9191
  • Fax: 865-450-9354
Mailing address:
  • Phone: 865-450-9191
  • Fax: 865-450-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN000002166
License Number StateTN

VIII. Authorized Official

Name: MRS. TRACY L HAWK
Title or Position: MANAGING MEMBER
Credential:
Phone: 865-450-9191