Provider Demographics
NPI:1235135963
Name:SIVLEY, RHONDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:S
Last Name:SIVLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:9333 PARK WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4317
Practice Address - Country:US
Practice Address - Phone:865-531-4600
Practice Address - Fax:833-908-2096
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37091207R00000X
TN43168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64054794Medicaid
TN1513967Medicaid
KYH63114Medicare UPIN
KY0793601Medicare ID - Type Unspecified
TN3041763Medicare PIN