Healthcare Provider Details

I. General information

NPI: 1265305353
Provider Name (Legal Business Name): JACQUELYN ELISE FREEMAN FARR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR STE 109
KNOXVILLE TN
37934-1980
US

IV. Provider business mailing address

10810 PARKSIDE DR STE 109
KNOXVILLE TN
37934-1980
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3350
  • Fax: 865-671-2666
Mailing address:
  • Phone: 865-647-3350
  • Fax: 865-671-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39506
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: