Healthcare Provider Details

I. General information

NPI: 1073164554
Provider Name (Legal Business Name): MERISSA JOHNSON FRYE APRN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERISSA JOHNSON FRYE MERISSA JOHNSON

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 KINGSTON PIKE STE 11
KNOXVILLE TN
37934-3065
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1382
US

V. Phone/Fax

Practice location:
  • Phone: 865-671-6720
  • Fax:
Mailing address:
  • Phone: 865-584-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26486
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: