Healthcare Provider Details

I. General information

NPI: 1164072559
Provider Name (Legal Business Name): KRISTIN MARIE GIPSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 145
KNOXVILLE TN
37920-1546
US

IV. Provider business mailing address

8943 WAVETREE DR
KNOXVILLE TN
37931-1450
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9749
  • Fax:
Mailing address:
  • Phone: 817-807-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN223411
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN26433
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: