Provider Demographics
NPI:1942687082
Name:WEST SIDE HEALTH PLLC
Entity Type:Organization
Organization Name:WEST SIDE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:TURPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-653-6311
Mailing Address - Street 1:9957 KINGSTON PIKE
Mailing Address - Street 2:STE. 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6908
Mailing Address - Country:US
Mailing Address - Phone:865-862-4575
Mailing Address - Fax:865-862-4574
Practice Address - Street 1:9957 KINGSTON PIKE
Practice Address - Street 2:STE. 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6908
Practice Address - Country:US
Practice Address - Phone:865-862-4575
Practice Address - Fax:865-862-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6075363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty