Provider Demographics
NPI:1881970044
Name:PIVONKA, CHRISTOPHER RYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:PIVONKA
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:4711 CENTERLINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1405
Mailing Address - Country:US
Mailing Address - Phone:865-647-3260
Mailing Address - Fax:865-647-3279
Practice Address - Street 1:4711 CENTERLINE DR STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1405
Practice Address - Country:US
Practice Address - Phone:865-647-3260
Practice Address - Fax:865-647-3279
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GUPA-82363A00000X
TN2336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant