Provider Demographics
NPI:1972678050
Name:KALLMER, SUNNY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:LYNN
Last Name:KALLMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2319
Mailing Address - Country:US
Mailing Address - Phone:865-801-9501
Mailing Address - Fax:865-801-9504
Practice Address - Street 1:9320 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2319
Practice Address - Country:US
Practice Address - Phone:865-801-9501
Practice Address - Fax:865-801-9504
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS80498Medicare UPIN
TX82N671Medicare ID - Type Unspecified