Provider Demographics
NPI:1154756658
Name:MICHELS, SALLY JO (CRNA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JO
Last Name:MICHELS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:410 N CEDAR BLUFF RD
Mailing Address - Street 2:STE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3632
Mailing Address - Country:US
Mailing Address - Phone:865-342-8900
Mailing Address - Fax:865-691-0843
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:37923-3632
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17996367500000X
KY3014230367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3014230OtherSTATE LICENSE