Provider Demographics
NPI:1881710333
Name:CHAMPION, DULCIE A
Entity type:Individual
Prefix:
First Name:DULCIE
Middle Name:A
Last Name:CHAMPION
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 1:350 STEELES RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-9532
Mailing Address - Country:US
Mailing Address - Phone:423-844-6700
Mailing Address - Fax:423-844-6703
Practice Address - Street 1:350 STEELES RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-9532
Practice Address - Country:US
Practice Address - Phone:423-844-6700
Practice Address - Fax:423-844-6703
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513353OtherTN CARE PN
TNPA306OtherLICENSE NUMBER
TN1513353OtherTN CARE PN