Provider Demographics
NPI:1619360773
Name:DAMRON, MICHAEL (APRN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DAMRON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S DAISY ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2362
Mailing Address - Country:US
Mailing Address - Phone:423-616-8315
Mailing Address - Fax:423-616-8316
Practice Address - Street 1:291 S DAISY ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2362
Practice Address - Country:US
Practice Address - Phone:423-616-8315
Practice Address - Fax:423-616-8316
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009277363LF0000X
TN31164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily