Healthcare Provider Details

I. General information

NPI: 1235498247
Provider Name (Legal Business Name): PRIMARY CARE OF TN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11509 HARDIN VALLEY RD STE 103
KNOXVILLE TN
37932-2316
US

IV. Provider business mailing address

11509 HARDIN VALLEY RD STE 103
KNOXVILLE TN
37932-2316
US

V. Phone/Fax

Practice location:
  • Phone: 865-712-2499
  • Fax: 865-381-1349
Mailing address:
  • Phone: 865-712-2499
  • Fax: 865-381-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number14589
License Number StateTN

VIII. Authorized Official

Name: DIANE KNIGHTS
Title or Position: OWNER
Credential: F.N.P.
Phone: 865-712-2499