Healthcare Provider Details

I. General information

NPI: 1316291768
Provider Name (Legal Business Name): MARY LOUISE WARD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

IV. Provider business mailing address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-6650
  • Fax: 865-305-5857
Mailing address:
  • Phone: 865-305-6650
  • Fax: 865-305-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15836
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128334
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: