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General NPI Number Information
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NPI Number | 1497008692
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Entity Type | Organization
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Legal Business Name | QO WELLNESS PC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 12744 KINGSTON PIKE SUITE 201
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City | KNOXVILLE
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State | TN
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Zip | 37934-0940
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Country | US
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Telephone | 865-274-7663
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Fax |
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Provider Business Mailing Address
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Address Line | 12744 KINGSTON PIKE SUITE 201
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City | KNOXVILLE
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State | TN
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Zip | 37934-0940
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Country | US
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Telephone | 865-274-7663
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN ORPURT
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Credential | LCSW
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Telephone | 865-548-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41361
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW3577
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License Number State | TN
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