Healthcare Provider Details

I. General information

NPI: 1548652548
Provider Name (Legal Business Name): MELISSA CHITTUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9314 PARK WEST BLVD SUITE 100
KNOXVILLE TN
37923-4330
US

IV. Provider business mailing address

9314 PARK WEST BLVD SUITE 100
KNOXVILLE TN
37923-4330
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-7677
  • Fax: 865-690-7627
Mailing address:
  • Phone: 865-690-7677
  • Fax: 865-690-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number19661
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: