Provider Demographics
NPI:1437331436
Name:BROYLES, RAVEN NICOLE (BS)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:NICOLE
Last Name:BROYLES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:NICOLE
Other - Last Name:PERKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8182
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:501 ADESA BLVD
Practice Address - Street 2:STE A-150
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771
Practice Address - Country:US
Practice Address - Phone:865-986-8082
Practice Address - Fax:865-986-5890
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator