MEDICARE: MEGAN K EDMISTEN NP-C

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	363LF0000X	Family Nurse Practitioner	20677	TN

General Provider Information

NPI Number	:	1902270069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN K EDMISTEN NP-C

Provider Business Mailing Address
First Line	:	9901 SIERRA VISTA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-5736
Country	:	US
Telephone Number	:	865-599-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 SIERRA VISTA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-5736
Country	:	US
Telephone Number	:	865-599-0300
Fax Number	:

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

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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