Healthcare Provider Details

I. General information

NPI: 1699767426
Provider Name (Legal Business Name): TRACY COVERDALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

IV. Provider business mailing address

PO BOX 631856
BALTIMORE MD
21263-1856
US

V. Phone/Fax

Practice location:
  • Phone: 865-293-5749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7601058642
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: