Provider Demographics
NPI:1396735288
Name:ANDERSON, DENISE ANN (NP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE BROOK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3761
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE BROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3761
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI431363L00000X
WI431-033363LW0102X
TN35681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ090614Medicaid
WI1396735288Medicaid
WIK400196300Medicare PIN
WI031T 73-601Medicare PIN
WI1396735288Medicaid