Provider Demographics
NPI:1992026827
Name:CUNNINGHAM, ROSE ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANNA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ANNA
Other - Last Name:WALDRIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 HIGGINS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3006
Mailing Address - Country:US
Mailing Address - Phone:865-999-8301
Mailing Address - Fax:865-999-8314
Practice Address - Street 1:301 HIGGINS AVE STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3006
Practice Address - Country:US
Practice Address - Phone:865-999-8301
Practice Address - Fax:865-999-8314
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN151690163W00000X
TNAPN15004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519008Medicaid
TN10350I2498Medicare PIN