Basic Information
Provider Information
NPI: 1285042861
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGREGOR
FirstName: ROBERT
MiddleName: K
NamePrefix:  
NameSuffix: JR.
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1225 E WEISGARBER RD
Address2: SUITE 200
City: KNOXVILLE
State: TN
PostalCode: 379092604
CountryCode: US
TelephoneNumber: 8655844747
FaxNumber: 8655841363
Practice Location
Address1: 2240 SUTHERLAND AVE
Address2: SUITE 104
City: KNOXVILLE
State: TN
PostalCode: 379192333
CountryCode: US
TelephoneNumber: 8659090090
FaxNumber: 8659099883
Other Information
ProviderEnumerationDate: 07/28/2014
LastUpdateDate: 08/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X18757TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
163W00000X161202TNN Nursing Service ProvidersRegistered Nurse 

No ID Information.


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