44D2189232 CLIA NUMBER - PEDIATRIC AND ADOLESCENT GYNECOLOGY

Laboratory Demographics

CLIA Number: 44D2189232

Facility Name: PEDIATRIC AND ADOLESCENT GYNECOLOGY

Facility Address:
2100 CLINCH AVE SUITE 310
KNOXVILLE, TN
ZIP 37916
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Facility Phone Number: 865 546-0221

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154731917

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	44D2189232
LAB Type	Physician Office
Facility Name	PEDIATRIC AND ADOLESCENT GYNECOLOGY
Street	2100 CLINCH AVE SUITE 310
City	KNOXVILLE
State	TN
ZIP	37916
Phone	865 546-0221
CertificateType	4
CertificateEffectiveDate	7/28/2022
CertificateExpirationDate	7/27/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024