Individual
JED MAVERICK NEWPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9352 PARK WEST BLVD, KNOXVILLE, TN 37923-4387
(865) 373-1000
Mailing address
1106 OAK HAVEN RD, KNOXVILLE, TN 37932-2628
(423) 215-4992
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
242968
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
37115
TN
Other
Enumeration date
09/06/2024
Last updated
10/11/2024
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