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Organization

DERMATOLOGY ASSOC.OF OAK RIDGE,PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JERRY A ALLEN APN-C (APN-C)
(865) 813-1009
Entity
Organization

Contact information

Practice address
800 OAK RIDGE TPKE, SUITE A-300, OAK RIDGE, TN 37830-6957
(865) 813-1009
(865) 482-4036
Mailing address
800 OAK RIDGE TPKE, SUITE A-300, OAK RIDGE, TN 37830-6957
(865) 813-1009
(865) 482-4036

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN0000013542
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
208001120
ANCC CERTIFICATE FOR FNP
TN
01
APN0000013542
CERTIFIED ADVANCED PRACTICE NURSE LICENSE
TN
Enumeration date
05/29/2008
Last updated
08/13/2008
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