Individual
EDA KICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3720 N BROADWAY ST, KNOXVILLE, TN 37917-3120
(865) 315-8353
(865) 314-8364
Mailing address
3720 N BROADWAY ST, KNOXVILLE, TN 37917-3120
(865) 315-8353
(865) 314-8364
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0000021275
TN
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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