Healthcare Provider Details

I. General information

NPI: 1942286521
Provider Name (Legal Business Name): PSYCHIATRIC CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1569
US

IV. Provider business mailing address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1569
US

V. Phone/Fax

Practice location:
  • Phone: 865-591-4703
  • Fax: 865-288-3303
Mailing address:
  • Phone: 865-591-4703
  • Fax: 865-288-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14934
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN0000077192
License Number StateTN

VIII. Authorized Official

Name: MR. ERNEST EUGENE PICKETT
Title or Position: SOLE OWNER
Credential: MSN
Phone: 865-591-4703