Provider Demographics
NPI:1407843519
Name:DOUGLAS, PATRICIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51406
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1406
Mailing Address - Country:US
Mailing Address - Phone:865-524-2739
Mailing Address - Fax:865-524-2739
Practice Address - Street 1:412 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2009
Practice Address - Country:US
Practice Address - Phone:865-882-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN33794367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105331OtherBLUE CROSS OF TENNESSEE
TN3148701OtherBCBS
TN3148701OtherBCBS
TN3600499Medicare ID - Type Unspecified
TN4105331OtherBLUE CROSS OF TENNESSEE