Provider Demographics
NPI:1639732746
Name:KNAUSE, REBEKAH LYNN
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:KNAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 DODGE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4506
Mailing Address - Country:US
Mailing Address - Phone:865-207-9588
Mailing Address - Fax:
Practice Address - Street 1:6712 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4831
Practice Address - Country:US
Practice Address - Phone:865-888-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN27-18022508OtherSOLE PROPRIETOR