Provider Demographics
NPI:1629009410
Name:RASMUSSEN, CARL A (PAC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2456
Mailing Address - Country:US
Mailing Address - Phone:865-584-0291
Mailing Address - Fax:865-584-4426
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2456
Practice Address - Country:US
Practice Address - Phone:865-584-0291
Practice Address - Fax:865-584-4426
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721933Medicare ID - Type Unspecified
R60712Medicare UPIN