Healthcare Provider Details

I. General information

NPI: 1710458724
Provider Name (Legal Business Name): SHANNON E JAMESON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY # U109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 51947
KNOXVILLE TN
37950-1947
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax: 865-637-5518
Mailing address:
  • Phone: 865-588-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25178
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: