Provider Demographics
NPI:1417603457
Name:SKYWAY FAMILY CARE
Entity type:Organization
Organization Name:SKYWAY FAMILY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSEPRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-999-8301
Mailing Address - Street 1:7643 TORCH LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-7598
Mailing Address - Country:US
Mailing Address - Phone:423-572-0134
Mailing Address - Fax:
Practice Address - Street 1:4206 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4251
Practice Address - Country:US
Practice Address - Phone:865-999-8301
Practice Address - Fax:865-999-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty