EDA KICKI (NPI# 1629527833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629527833 |
| Entity Type | Individual |
| Full Name | EDA KICKI |
| Credential | N.P. |
| Practice Address |
3720 N Broadway St Knoxville TN 37917-3120 |
| Practice Telephone | 8653158353 |
| Practice Fax Number | 8653148364 |
| Mailing Telephone | 8653158353 |
| Mailing Fax Number | 8653148364 |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
0000021275 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3720 N BROADWAY ST |
| City | KNOXVILLE |
| State | TN |
| Zip Code | 37917-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669644373 | Jessica L Livingston | Registered Nurse | 3720 N Broadway St, Knoxville, TN 37917-3120 | 2008-04-02 |
| 1265973028 | Livingston Family Services | Registered Nurse | 3720 N Broadway St, Knoxville, TN 37917-3120 | 2017-03-13 |
| 1942750773 | Jessica Livingston Msn Aprn | Clinic/Center | 3720 N Broadway St, Knoxville, TN 37917-3120 | 2016-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033601786 | Angela Marie Barnett | Licensed Practical Nurse | 201 W Springdale Ave # 203, Knoxville, TN 37917 | 2018-05-30 |
| 1790283588 | Kevin Johnson | Case Manager/Care Coordinator | 201 W. Springfield Ave, Knoxville, TN 37917 | 2018-01-26 |
| 1871011437 | Sara Portwood | Registered Nurse | 140 Dameron Ave., Knoxville, TN 37917 | 2017-09-05 |
| 1962926295 | Dara Steele | Counselor | 201 West Springdale, Knoxville, TN 37917 | 2017-07-28 |
| 1043740657 | Stacy Banks | Counselor | 201 West Springdale Ave., Knoxville, TN 37917 | 2017-06-15 |
| 1861921215 | Amy J Mccowan | Registered Nurse | 201 W. Springdale Ave., Knoxville, TN 37917 | 2017-06-08 |
| 1942756523 | Skyler Daegan Winkler | Counselor | 201 West Springvale Avenue, Knoxville, TN 37917 | 2016-09-01 |
| 1821454216 | Beth Cannon | Case Manager/Care Coordinator | 201 West Sprindale Ave, Knoxville, TN 37917 | 2016-01-14 |
| 1760874986 | Sierra Brooke Finley | Case Manager/Care Coordinator | 201 W. Springdale Ave, Knoxville, TENNESSEE 37917 | 2015-02-25 |
| 1568860377 | Megumi Takayama Maynard | Family Medicine | 900 E. Oak Hill Avenue, Knoxville, TN 37917 | 2014-12-10 |
| Find all providers in zip 37917 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265098388 | Emily Katherine Hayes | Nurse Practitioner | 6626 Old Central Avenue Pike, Knoxville, TN 37912 | 2019-05-14 |
| 1548678352 | Kristi Osborne | Nurse Practitioner | 2620 Mineral Springs Ave Ste A, Knoxville, TN 37917-1570 | 2014-07-24 |
| 1740422013 | Carol Preston | Nurse Practitioner | 314 Kennon Rd, Knoxville, TN 37909-3032 | 2009-04-01 |
| 1154523124 | Psychiatric Specialist, LLC | Nurse Practitioner | 8236 Glenrothes Blvd, Knoxville, TN 37909-2158 | 2007-06-01 |
| 1457412157 | Christina G Raman | Nurse Practitioner | 1111 N Northshore Dr Ste 490, Knoxville, TN 37919-4005 | 2006-12-13 |
| 1073609764 | Darneta G Brown | Nurse Practitioner | 2606 Greenway Drive, Suite 105, Knoxville, TN 37918 | 2006-10-04 |
| 1003925942 | Jill Powell | Nurse Practitioner | 3715 Sutherland Ave, Knoxville, TN 37919-4338 | 2006-08-30 |
| 1205804994 | Susan Goolsby | Nurse Practitioner | 116 Concord Rd Ste 100, Knoxville, TN 37934-2941 | 2006-03-09 |
| 1306824263 | Carol Kraemer Witherington | Nurse Practitioner | 5908 Lyons View Pike, Knoxville, TN 37919-7520 | 2006-01-02 |
| 1942286521 | Psychiatric Concepts, LLC | Nurse Practitioner | 2620 Mineral Springs Ave, Suite A, Knoxville, TN 37917-1569 | 2005-12-15 |
| Find all providers in KNOXVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.