Provider Demographics
NPI:1265031637
Name:TEVIS, MARLEE MAXWELL (PA-C)
Entity Type:Individual
Prefix:
First Name:MARLEE
Middle Name:MAXWELL
Last Name:TEVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 ARBURY WAY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5001
Mailing Address - Country:US
Mailing Address - Phone:423-238-8880
Mailing Address - Fax:423-238-8881
Practice Address - Street 1:6059 ARBURY WAY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5001
Practice Address - Country:US
Practice Address - Phone:423-238-8880
Practice Address - Fax:423-238-8881
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA4370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant