Provider Demographics
NPI:1639861859
Name:WASHAM, HALI ALEXANDRA
Entity Type:Individual
Prefix:
First Name:HALI
Middle Name:ALEXANDRA
Last Name:WASHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-2011
Mailing Address - Country:US
Mailing Address - Phone:931-303-1746
Mailing Address - Fax:
Practice Address - Street 1:110 MAJESTIC GROVE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6485
Practice Address - Country:US
Practice Address - Phone:865-573-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily