Provider Demographics
NPI:1679179295
Name:KEAR, LARISSA VIOLA (FNP)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:VIOLA
Last Name:KEAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:VIOLA
Other - Last Name:GHOLSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:895-544-1861
Practice Address - Street 1:1415 OLD WEISGARBER RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1341
Practice Address - Country:US
Practice Address - Phone:865-934-5800
Practice Address - Fax:865-934-5801
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily