MEDICARE: BRIA WALL BOUKOVALAS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	30655	TN

General Provider Information

NPI Number	:	1962863621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIA WALL BOUKOVALAS CRNA

Provider Business Mailing Address
First Line	:	1061 HAYSLOPE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-7228
Country	:	US
Telephone Number	:	281-732-3033
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N WEISGARBER RD STE 500
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2708
Country	:	US
Telephone Number	:	865-588-1662
Fax Number	:

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

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/03/2026

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