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General NPI Number Information
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NPI Number | 1881970044
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Entity Type | Individual
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Provider Name | CHRISTOPHER RYAN PIVONKA PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 4711 CENTERLINE DR STE 100
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City | KNOXVILLE
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State | TN
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Zip | 37917-1405
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Country | US
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Telephone | 865-647-3260
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Fax | 865-647-3279
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Provider Business Mailing Address
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Address Line | 4711 CENTERLINE DR STE 100
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City | KNOXVILLE
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State | TN
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Zip | 37917-1405
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Country | US
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Telephone | 865-647-3260
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Fax | 865-647-3279
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-82
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License Number State | GU
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2336
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License Number State | TN
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