Provider Demographics
NPI:1639527583
Name:DUMONT, PHYLLIS M (PHD, MSN, APN)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:M
Last Name:DUMONT
Suffix:
Gender:F
Credentials:PHD, MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N PARK 40 BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3615
Mailing Address - Country:US
Mailing Address - Phone:865-693-1570
Mailing Address - Fax:
Practice Address - Street 1:421 N PARK 40 BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3615
Practice Address - Country:US
Practice Address - Phone:865-693-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000015178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily