Healthcare Provider Details

I. General information

NPI: 1619635596
Provider Name (Legal Business Name): RAYMOND JOSEPH FERNANDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7714 CONNER RD STE 103
POWELL TN
37849-3559
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 659-388-1218
  • Fax: 865-212-5561
Mailing address:
  • Phone: 865-306-5700
  • Fax: 865-584-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: