Provider Demographics
NPI:1558806745
Name:YASIN, MEIRA
Entity Type:Individual
Prefix:
First Name:MEIRA
Middle Name:
Last Name:YASIN
Suffix:
Gender:F
Credentials:
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 52391
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2391
Mailing Address - Country:US
Mailing Address - Phone:865-384-7476
Mailing Address - Fax:865-381-1205
Practice Address - Street 1:365 STOUT DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-1703
Practice Address - Country:US
Practice Address - Phone:423-433-6057
Practice Address - Fax:423-433-6060
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22082363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027675Medicaid
TN22082OtherSTATE LICENSE