Healthcare Provider Details

I. General information

NPI: 1407414352
Provider Name (Legal Business Name): ANKUR PATEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STONECREST BLVD
SMYRNA TN
37167-6810
US

IV. Provider business mailing address

1712 HOURGLASS PT
HIXSON TN
37343-3298
US

V. Phone/Fax

Practice location:
  • Phone: 615-786-2000
  • Fax:
Mailing address:
  • Phone: 423-400-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number195106
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3014022
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number38586
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: