Healthcare Provider Details

I. General information

NPI: 1033622725
Provider Name (Legal Business Name): COURTNEY ROTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 DANNAHER DR STE 100
POWELL TN
37849-4066
US

IV. Provider business mailing address

6016 BROOKVALE LN STE 200
KNOXVILLE TN
37919-4092
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9330
  • Fax: 865-512-6748
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number23255
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23255
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: