Provider Demographics
NPI:1194350678
Name:PEREZ-RIOS, ILIENIS (PA-C)
Entity type:Individual
Prefix:
First Name:ILIENIS
Middle Name:
Last Name:PEREZ-RIOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 DOWELL SPRINGS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-637-8812
Mailing Address - Fax:865-637-8865
Practice Address - Street 1:122 KENT PLACE
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-637-8812
Practice Address - Fax:865-342-4678
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112956363A00000X
TN4101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ057212Medicaid