Healthcare Provider Details

I. General information

NPI: 1073650438
Provider Name (Legal Business Name): MICHAEL KEVIN LAWSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5132
US

IV. Provider business mailing address

447 WATAUGA AVE
KNOXVILLE TN
37917-3636
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-4582
  • Fax: 865-983-4574
Mailing address:
  • Phone: 865-688-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000110814
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: