Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19042 | TN |
NPI | 1003231010 |
---|---|
Provider Name | Carla Tipton |
First Address | Knoxville, TN 37909-2441 |
Second Address | Knoxville, TN 37909-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 22/09/2014 |