Healthcare Provider Details

I. General information

NPI: 1609389097
Provider Name (Legal Business Name): JOHN BOCKMANN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 HIGHWAY 321 N STE C
LENOIR CITY TN
37771-6001
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1382
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-4747
  • Fax: 865-381-1509
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6868
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: