Healthcare Provider Details

I. General information

NPI: 1871887430
Provider Name (Legal Business Name): NITEOWL PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 LEE HWY STE 103
OOLTEWAH TN
37363-4440
US

IV. Provider business mailing address

9219 LEE HWY STE 103
OOLTEWAH TN
37363-4440
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-6483
  • Fax: 423-648-6497
Mailing address:
  • Phone: 423-648-6483
  • Fax: 423-648-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PRITCHETT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 423-648-6483