Provider Demographics
NPI:1689624439
Name:MCCULLAR, CLARISSA M (NP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:M
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:801 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6916
Practice Address - Country:US
Practice Address - Phone:865-483-3172
Practice Address - Fax:865-483-8689
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN7012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S88524Medicare UPIN