Individual
LEVI JORDAN GAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9352 PARK WEST BLVD, KNOXVILLE, TN 37923-4325
(865) 373-1000
Mailing address
11393 HAWKSTOWE LN, FARRAGUT, TN 37934-4838
(865) 368-9056
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN0000027112
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/29/2019
Last updated
02/24/2020
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