Provider Demographics
NPI:1740362037
Name:BYRUM, JAIME DAVIS (PNP, FNP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:DAVIS
Last Name:BYRUM
Suffix:
Gender:F
Credentials:PNP, FNP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:D
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:930 ADELL REE PARK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2543
Mailing Address - Country:US
Mailing Address - Phone:865-769-2600
Mailing Address - Fax:865-769-2616
Practice Address - Street 1:930 ADELL REE PARK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2543
Practice Address - Country:US
Practice Address - Phone:865-769-2600
Practice Address - Fax:865-769-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8099363LP0200X
TN8099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510086Medicaid