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General NPI Number Information
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NPI Number | 1710145537
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOC.OF OAK RIDGE,PC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 800 OAK RIDGE TPKE SUITE A-300
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-813-1009
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Fax | 865-482-4036
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Provider Business Mailing Address
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Address Line | 800 OAK RIDGE TPKE SUITE A-300
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-813-1009
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Fax | 865-482-4036
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Authorized Official
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Title or Position | APN-C
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Name | MS. JERRY A ALLEN
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Credential | APN-C
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Telephone | 865-813-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN0000013542
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License Number State | TN
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