Provider Demographics
NPI:1043257843
Name:MOTTERN, JOE DAVID (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:DAVID
Last Name:MOTTERN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 BAUM DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7360
Mailing Address - Country:US
Mailing Address - Phone:865-584-5727
Mailing Address - Fax:865-450-9904
Practice Address - Street 1:1410 TUSCULUM BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4286
Practice Address - Country:US
Practice Address - Phone:423-823-5190
Practice Address - Fax:423-823-5193
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN00000100379363L00000X
TNAPN6999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903829Medicaid
TN3903822Medicaid
TN3903821Medicaid
TNS58833OtherUPIN
TN3903827Medicaid
TN3903820Medicaid
TN3903829Medicare PIN
TN3903822Medicaid
TN3903821Medicare PIN
TNS58833OtherUPIN
TN3903821Medicaid