Healthcare Provider Details

I. General information

NPI: 1346565009
Provider Name (Legal Business Name): MARY ANN HAMMONDS MSN ADULT NURSE PRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FORT SANDERS WEST BLVD STE 200
KNOXVILLE TN
37922-3471
US

IV. Provider business mailing address

180 LEISZ RD
HARRIMAN TN
37748-4327
US

V. Phone/Fax

Practice location:
  • Phone: 865-288-4232
  • Fax: 865-288-4231
Mailing address:
  • Phone: 865-394-9078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: