Provider Demographics
NPI:1114935244
Name:GRAVELL, AUNDREA L (RRT)
Entity Type:Individual
Prefix:MRS
First Name:AUNDREA
Middle Name:L
Last Name:GRAVELL
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6290
Mailing Address - Country:US
Mailing Address - Phone:423-788-0211
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT ST
Practice Address - Street 2:JAMES H. QUILLEN/VAMC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-3500
Practice Address - Fax:423-979-3471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1127227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered