1376848812 NPI number — JOHN PATRICK MCCORMICK FNP

Table of content: JOHN PATRICK MCCORMICK FNP (NPI 1376848812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376848812 NPI number — JOHN PATRICK MCCORMICK FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMICK
Provider First Name:
JOHN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376848812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9221 MIDDLEBROOK PIKE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
KNOXVILE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-539-2873
Provider Business Mailing Address Fax Number:
865-539-2969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 ESSARY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37918-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-243-3754
Provider Business Practice Location Address Fax Number:
865-243-2250
Provider Enumeration Date:
01/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  15182 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1527269 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: NONE . This is a "NONE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com