Provider Demographics
NPI:1952737942
Name:PRATT, MARTIREA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARTIREA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARTIREA
Other - Middle Name:
Other - Last Name:JENKINS PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6224 CHRISTIAN SPRINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721
Mailing Address - Country:US
Mailing Address - Phone:865-660-3728
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR STE G10
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-218-7525
Practice Address - Fax:865-218-7526
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000017858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily