Healthcare Provider Details

I. General information

NPI: 1942687082
Provider Name (Legal Business Name): WEST SIDE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9957 KINGSTON PIKE STE. 105
KNOXVILLE TN
37922-6908
US

IV. Provider business mailing address

9957 KINGSTON PIKE STE. 105
KNOXVILLE TN
37922-6908
US

V. Phone/Fax

Practice location:
  • Phone: 865-862-4575
  • Fax: 865-862-4574
Mailing address:
  • Phone: 865-862-4575
  • Fax: 865-862-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6075
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6075
License Number StateTN

VIII. Authorized Official

Name: MARYLOU TURPIN
Title or Position: CPC CREDENTIALING
Credential:
Phone: 615-653-6311