Basic Information
| Provider Information | |||||||||
| NPI: | 1689165334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | DEVAN | ||||||||
| MiddleName: | LAURA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 SUTHERLAND AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655888831 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2240 SUTHERLAND AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655888831 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2018 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | 24363 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163WG0000X | 149300 | TN | N | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.