Healthcare Provider Details

I. General information

NPI: 1619871720
Provider Name (Legal Business Name): TREVA RAE VALENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N PARK 40 BLVD
KNOXVILLE TN
37923-3624
US

IV. Provider business mailing address

194 JOHN J DUNCAN PKWY
ATHENS TN
37303-7069
US

V. Phone/Fax

Practice location:
  • Phone: 865-692-3462
  • Fax:
Mailing address:
  • Phone: 937-529-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: