Provider Demographics
NPI:1396276267
Name:RICKELS, ALLI N (NP)
Entity type:Individual
Prefix:
First Name:ALLI
Middle Name:N
Last Name:RICKELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLI
Other - Middle Name:N
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:221 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3815
Practice Address - Country:US
Practice Address - Phone:423-787-6050
Practice Address - Fax:423-787-6054
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22376363LP0200X, 363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027647Medicaid