Provider Demographics
NPI:1386066694
Name:HEWGLEY, EVAN J (PA)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:J
Last Name:HEWGLEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:610 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3414
Practice Address - Country:US
Practice Address - Phone:423-625-7777
Practice Address - Fax:423-625-4903
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2020-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002908Medicaid