Provider Demographics
NPI:1326500927
Name:KOWALESKI, RACHEL MEGAN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MEGAN
Last Name:KOWALESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2018
Mailing Address - Country:US
Mailing Address - Phone:865-591-4454
Mailing Address - Fax:
Practice Address - Street 1:9625 KROGER PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-8800
Practice Address - Country:US
Practice Address - Phone:865-531-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine