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General NPI Number Information
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NPI Number | 1578055836
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Entity Type | Individual
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Provider Name | CARLOS ALEXANDER ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 06/03/2018
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Last Update Date | 06/03/2018
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Provider Practice Location Address
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Address Line | 312 PRINCE ST
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City | SEVIERVILLE
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State | TN
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Zip | 37862-3823
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Country | US
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Telephone | 865-744-7684
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Fax |
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Provider Business Mailing Address
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Address Line | 10546 ARNOLD LANE
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City | MASCOT
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State | TN
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Zip | 37806
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Country | US
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Telephone | 865-304-6774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 210522
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 24112
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License Number State | TN
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