Provider Demographics
NPI:1730309733
Name:WOOTEN, ROXANNE DAVIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:DAVIS
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 HIGHLAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4953
Mailing Address - Country:US
Mailing Address - Phone:423-472-1036
Mailing Address - Fax:
Practice Address - Street 1:540 MCCALLIE AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2089
Practice Address - Country:US
Practice Address - Phone:423-634-3124
Practice Address - Fax:423-634-3139
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39266163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health