Provider Demographics
NPI:1598836900
Name:LAWSON, GLENNIS DARRELL JR (MSN-CRNA)
Entity Type:Individual
Prefix:MR
First Name:GLENNIS
Middle Name:DARRELL
Last Name:LAWSON
Suffix:JR
Gender:M
Credentials:MSN-CRNA
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Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:919 E. CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2055
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-03-22
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Provider Licenses
StateLicense IDTaxonomies
TNAPN11154367500000X
TN128612367500000X
TN11154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506017Medicaid
KY74010061Medicaid
TN4178543OtherBLUE CROSS/BLUE SHIELD
KY74010661Medicaid
P00632153OtherRAILROAD MEDICARE
TN4110437OtherIND BC PROVIDER NUMBER
TN4178543OtherBLUE CROSS/BLUE SHIELD
P00632153OtherRAILROAD MEDICARE