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General NPI Number Information
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NPI Number | 1790271922
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Entity Type | Individual
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Provider Name | MICAH BAYLEA TROUTMAN
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 11653 CHAPMAN HWY
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City | SEYMOUR
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State | TN
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Zip | 37865-5099
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Country | US
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Telephone | 865-773-0327
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Fax |
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Provider Business Mailing Address
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Address Line | 8731 TIGRIS POINTE LN
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City | KNOXVILLE
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State | TN
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Zip | 37924-3443
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Country | US
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Telephone | 865-254-0686
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24417
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License Number State | TN
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