Provider Demographics
NPI:1912149279
Name:PANKRATZ, JACKIE GIVENS (APN)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:GIVENS
Last Name:PANKRATZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901
Mailing Address - Country:US
Mailing Address - Phone:865-522-9730
Mailing Address - Fax:865-637-2520
Practice Address - Street 1:1975 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6638
Practice Address - Country:US
Practice Address - Phone:865-546-3998
Practice Address - Fax:865-546-1123
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
4235389OtherBCBS
TN1513938Medicaid
TN1513938Medicaid