Provider Demographics
NPI:1629590070
Name:CERONE, EDYTH PATRICIA (NP)
Entity Type:Individual
Prefix:MS
First Name:EDYTH
Middle Name:PATRICIA
Last Name:CERONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NIGHBERT LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5400
Mailing Address - Country:US
Mailing Address - Phone:865-806-2220
Mailing Address - Fax:865-966-2914
Practice Address - Street 1:111 CENTER PARK DR STE 115
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2121
Practice Address - Country:US
Practice Address - Phone:865-806-2220
Practice Address - Fax:865-966-2914
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health