=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801524624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW PATH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 08/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 TAZEWELL PIKE STE G
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-1880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-215-1862
-----------------------------------------------------
Fax | 877-356-1693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4956
-----------------------------------------------------
City | ONEIDA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37841-4956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-215-1862
-----------------------------------------------------
Fax | 377-356-1693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL BILBREY
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 423-215-1862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------