Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 20717 | TN |
NPI | 1043683329 |
---|---|
Provider Name | Heather Massengill |
First Address | Knoxville, TN 37920-1511 |
Second Address | Knoxville, TN 37920-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 22/02/2017 |