Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN8015 | TN |
NPI | 1013043819 |
---|---|
Provider Name | Mr. Benjamin Batchelor |
First Address | Knoxville, TN 37916-2203 |
Second Address | Knoxville, TN 37916-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APN8015 | LICENSE (01) | TN |
MB0862309 | DEA (01) | TN |