Provider Demographics
NPI:1720745342
Name:DORRIS, ANDIE MICHELLE
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:MICHELLE
Last Name:DORRIS
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 1:1211 HIGHLAND AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1563
Mailing Address - Country:US
Mailing Address - Phone:423-987-6280
Mailing Address - Fax:
Practice Address - Street 1:1211 HIGHLAND AVE APT 205
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1563
Practice Address - Country:US
Practice Address - Phone:423-987-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN245579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse