Healthcare Provider Details

I. General information

NPI: 1407874860
Provider Name (Legal Business Name): MARY JANE HARLAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 KINGSTON PIKE
KNOXVILLE TN
37919-5703
US

IV. Provider business mailing address

PO BOX 316
CORRYTON TN
37721-0316
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3031
  • Fax: 865-992-8103
Mailing address:
  • Phone: 865-992-3031
  • Fax: 865-992-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 6032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: