Provider Demographics
NPI:1154367233
Name:DAVIS, HAZEL CHARLENE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:CHARLENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:435 2ND STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3703
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN114338367500000X
TN10522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3151319OtherBLUECARE
TN3902431Medicaid
TN3902437Medicaid
TN3151319OtherBLUE CROSS
TNP00813082OtherRAILROAD MEDICARE PIN
TN100031526OtherPHP TENNCARE
TN4195271OtherBLUE CROSS/BLUE SHIELD
TN430059022OtherMEDICARE TRAVELERS
TN3151319OtherBLUE CROSS
TN3902437Medicaid