Healthcare Provider Details

I. General information

NPI: 1134885296
Provider Name (Legal Business Name): VICTORIA LAYNE BURRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

940 LOUISVILLE RD
ALCOA TN
37701-1808
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9300
  • Fax:
Mailing address:
  • Phone: 865-806-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number30623
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: