Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 17646 | TN |
N | 363LA2200X | Nurse Practitioner - Adult Health | 17646 | TN |
NPI | 1013353176 |
---|---|
Provider Name | Joanna Grace Adams |
First Address | Knoxville, TN 37930-2569 |
Second Address | Knoxville, TN 37923-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 05/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1532907 | (05) | TN |