Provider Demographics
NPI:1285639369
Name:UNDERWOOD, TRICIA W (NP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:W
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PARK WEST BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4312
Mailing Address - Country:US
Mailing Address - Phone:865-690-3003
Mailing Address - Fax:865-374-2143
Practice Address - Street 1:9330 PARK WEST BLVD STE 402
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4312
Practice Address - Country:US
Practice Address - Phone:865-690-3003
Practice Address - Fax:865-374-2143
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6682363L00000X
TN6682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019387Medicaid
3901783Medicare ID - Type Unspecified