Icp Tennessee, LLC

Primary specialty

Clinical Nurse SpecialistTaxonomy code 364S00000X

Legal business name

ICP TENNESSEE, LLC

Practice address

200 Prosperity Place
Knoxville, TN 37923

Phone

(855) 498-6767

Fax

(479) 968-1673

NPI assigned

May 19, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rodney Thomason

Title

Authorized Official

Phone

(855) 498-6767

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1205247699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728119178",
            "telephone_number": "855-498-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PROSPERITY PLACE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37923",
            "telephone_number": "855-498-6767",
            "fax_number": "479-968-1673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "746 Crossover Ln",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381174905",
            "country_code": "US",
            "telephone_number": "855-498-6767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICP TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "THOMASON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "855-498-6767"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Nurse Specialist in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Clinical Nurse Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.