Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD019327 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | MD019327 | TN |
NPI | 1023053188 |
---|---|
Provider Name | Dr. Jeanann Pardue |
First Address | Knoxville, TN 37923-6755 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3028620 | BLUE CROSS (01) | TN |
3055911 | (05) | TN |
64797160 | (05) | KY |