Healthcare Provider Details

I. General information

NPI: 1134668379
Provider Name (Legal Business Name): RYAN DAVIS DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax: 865-546-1123
Mailing address:
  • Phone: 443-462-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAC002679
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22306
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: