Healthcare Provider Details

I. General information

NPI: 1578750733
Provider Name (Legal Business Name): LAUREN BELL GAYLORD RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4529 ASHEVILLE HWY
KNOXVILLE TN
37914-3607
US

IV. Provider business mailing address

4529 ASHEVILLE HWY
KNOXVILLE TN
37914-3607
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-8114
  • Fax: 865-522-1161
Mailing address:
  • Phone: 865-522-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN0000155575
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: