Healthcare Provider Details

I. General information

NPI: 1760078125
Provider Name (Legal Business Name): KARA B LARUE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9142 S NORTHSHORE DR
KNOXVILLE TN
37922-6325
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-670-1560
  • Fax: 833-908-2111
Mailing address:
  • Phone: 865-584-4747
  • Fax: 833-908-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28711
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197769
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: