Provider Demographics
NPI:1386655264
Name:JARVIS, KRISTEN D (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:JARVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 CENTERLINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1405
Mailing Address - Country:US
Mailing Address - Phone:865-647-3260
Mailing Address - Fax:865-647-3279
Practice Address - Street 1:4711 CENTERLINE DR STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1405
Practice Address - Country:US
Practice Address - Phone:865-647-3260
Practice Address - Fax:865-647-3279
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2536207P00000X
TNDO2536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00689414OtherMEDICARE RAIL ROAD
IN259370DMedicare PIN