Healthcare Provider Details

I. General information

NPI: 1003182239
Provider Name (Legal Business Name): MAGGIE ELLINE KECK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CATLETT RD
SEVIERVILLE TN
37862-5901
US

IV. Provider business mailing address

9325 S NORTHSHORE DR
KNOXVILLE TN
37922-6548
US

V. Phone/Fax

Practice location:
  • Phone: 865-330-7425
  • Fax: 865-333-5848
Mailing address:
  • Phone: 865-330-7425
  • Fax: 865-333-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: