MEDICARE: DOUGLAS H LUTTRELL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN92050	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500028566	OTHER	TN	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114954641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS H LUTTRELL NP

Provider Business Mailing Address
First Line	:	1225 E WEISGARBER RD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2604
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 E EMERALD AVE
Second Line	:	STE 813
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4539
Country	:	US
Telephone Number	:	865-546-9751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	05/08/2008

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