Provider Demographics
NPI:1235498247
Name:PRIMARY CARE OF TN, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF TN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-712-2499
Mailing Address - Street 1:11509 HARDIN VALLEY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2316
Mailing Address - Country:US
Mailing Address - Phone:865-712-2499
Mailing Address - Fax:865-381-1349
Practice Address - Street 1:11509 HARDIN VALLEY RD
Practice Address - Street 2:STE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2316
Practice Address - Country:US
Practice Address - Phone:865-712-2499
Practice Address - Fax:865-381-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14589364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty