Provider Demographics
NPI:1124124664
Name:BAUCOM, CHRISTOPHER BRYAN (ARNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BRYAN
Last Name:BAUCOM
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 STILLWATER CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4842
Mailing Address - Country:US
Mailing Address - Phone:423-653-5612
Mailing Address - Fax:
Practice Address - Street 1:410 N CEDAR BLUFF RD
Practice Address - Street 2:STE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3623
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2961222363LF0000X
TNAPN14319367500000X
TNRN132292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516428Medicaid
TN4239486OtherBCBS OF TN
TN435775Medicare PIN