Provider Demographics
NPI:1376848812
Name:MCCORMICK, JOHN PATRICK (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 MIDDLEBROOK PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KNOXVILE
Mailing Address - State:TN
Mailing Address - Zip Code:37931
Mailing Address - Country:US
Mailing Address - Phone:865-539-2873
Mailing Address - Fax:865-539-2969
Practice Address - Street 1:2911 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2468
Practice Address - Country:US
Practice Address - Phone:865-243-3754
Practice Address - Fax:865-243-2250
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527269Medicaid
NONEOtherNONE
NONEOtherNONE