Provider Demographics
NPI:1700923331
Name:BICKFORD, GARY R (PHD, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:BICKFORD
Suffix:
Gender:M
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PERIMETER PARK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2200
Mailing Address - Country:US
Mailing Address - Phone:865-247-6340
Mailing Address - Fax:865-241-5966
Practice Address - Street 1:110 PERIMETER PARK RD
Practice Address - Street 2:SUITE G
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2200
Practice Address - Country:US
Practice Address - Phone:865-247-6340
Practice Address - Fax:865-241-5966
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000012264OtherSTATE LICENSE