Provider Demographics
NPI:1578971263
Name:DEMOURA, WINDY MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:WINDY
Middle Name:MICHELLE
Last Name:DEMOURA
Suffix:
Gender:F
Credentials:APRN
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 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:601-533-7016
Practice Address - Street 1:4221 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-3508
Practice Address - Country:US
Practice Address - Phone:865-392-7264
Practice Address - Fax:858-516-5891
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18914363LF0000X
FLAPRN9385696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN452687190OtherTAX ID
TNQ008681Medicaid
TN10350I4815Medicare PIN
TNQ008681Medicaid