Provider Demographics
NPI:1629274345
Name:DOTY, LAURA P (ARPN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:DOTY
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 ROYAL PARKWAY, SUITE #101
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214
Mailing Address - Country:US
Mailing Address - Phone:615-889-7664
Mailing Address - Fax:
Practice Address - Street 1:9200 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629274345OtherNPI
TNDG0887OtherMEDICARE RAIL ROAD
TN3370042Medicare UPIN