Provider Demographics
NPI:1992172399
Name:RIVERS, JOHNNY RAY (FNP)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:RAY
Last Name:RIVERS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LOVELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1903
Mailing Address - Country:US
Mailing Address - Phone:865-288-7777
Mailing Address - Fax:865-288-7775
Practice Address - Street 1:108 LOVELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1903
Practice Address - Country:US
Practice Address - Phone:865-288-7777
Practice Address - Fax:865-288-7775
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20336363LP2300X
TNAPN20336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20336OtherLICENSE NUMBER