Individual
CARRIE B WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
414 GREENBELT DR, MARYVILLE, TN 37804-5702
(865) 637-8812
(865) 342-4678
Mailing address
1450 DOWELL SPRINGS BLVD, SUITE 300, KNOXVILLE, TN 37909
(865) 637-8812
(865) 637-8865
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
16556
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q005787
—
TN
Enumeration date
03/22/2012
Last updated
06/18/2025
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