Provider Demographics
NPI:1457465890
Name:TURBEVILLE, LORETTA ROSE (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ROSE
Last Name:TURBEVILLE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-5100
Mailing Address - Country:US
Mailing Address - Phone:865-809-2033
Mailing Address - Fax:888-657-5448
Practice Address - Street 1:112 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-5100
Practice Address - Country:US
Practice Address - Phone:865-809-2033
Practice Address - Fax:888-657-5448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63788163WG0000X
TN12184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506272Medicaid
TN3341406OtherMEDICARE INDIVIDUAL PTAN