Provider Demographics
NPI:1285293704
Name:AUSTIN, JEREMY (NP-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DR STE G15
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1921
Mailing Address - Country:US
Mailing Address - Phone:865-218-7444
Mailing Address - Fax:865-218-7445
Practice Address - Street 1:10810 PARKSIDE DR STE G15
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1921
Practice Address - Country:US
Practice Address - Phone:865-218-7444
Practice Address - Fax:865-218-7445
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN26151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner