Healthcare Provider Details

I. General information

NPI: 1427710128
Provider Name (Legal Business Name): RACHELLE GANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9303 PARK WEST BLVD STE 100
KNOXVILLE TN
37923-4304
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-951-0083
  • Fax: 833-908-2101
Mailing address:
  • Phone: 865-584-4747
  • Fax: 833-908-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30469
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: