Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 609 | TN |
Y | 213ES0000X | Sports Medicine | 609 | TN |
NPI | 1154720654 |
---|---|
Provider Name | Carissa Andres |
First Address | Sevierville, TN 37876-9502 |
Second Address | Pigeon Forge, TN 37863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |