Provider Demographics
NPI:1689165334
Name:FOX, DEVAN LAURA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEVAN
Middle Name:LAURA
Last Name:FOX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 SUTHERLAND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2333
Mailing Address - Country:US
Mailing Address - Phone:865-588-8831
Mailing Address - Fax:
Practice Address - Street 1:2240 SUTHERLAND AVE STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN24363363LF0000X
TN149300163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice