| Revitalist | |
|
10608 Flickenger Ln Knoxville TN 37922-3485 | |
| (865) 392-6262 | |
| Not Available |
| Full Name | Revitalist |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10608 Flickenger Ln, Knoxville, Tennessee |
| Authorized Official Name and Position | Kathryn Walker (PRINCIPAL EMPLOYEE) |
| Authorized Official Contact | 8653926262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalist 10608 Flickenger Ln Knoxville TN 37922-3485 Ph: () - | Revitalist 10608 Flickenger Ln Knoxville TN 37922-3485 Ph: (865) 392-6262 |
| NPI Number | 1073168241 |
|---|---|
| Provider Enumeration Date | 08/05/2019 |
| Last Update Date | 03/07/2025 |
| Certification Date | 03/07/2025 |
| Medicare PECOS PAC ID | 6800295650 |
|---|---|
| Medicare Enrollment ID | O20210527000088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073168241 | NPI | - | NPPES |
| Provider Name | William A Walker |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1770551368 PECOS PAC ID: 7214831569 Enrollment ID: I20031215000130 |
| Provider Name | Chelia Ann Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730206129 PECOS PAC ID: 3072683192 Enrollment ID: I20080602000486 |
| Provider Name | Paul W Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407820863 PECOS PAC ID: 6406844497 Enrollment ID: I20090128000555 |
| Provider Name | Cara C Fisk |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972809648 PECOS PAC ID: 0244414043 Enrollment ID: I20110401000483 |
| Provider Name | Laura L Bland |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043552003 PECOS PAC ID: 3577703438 Enrollment ID: I20130717000561 |
| Provider Name | Kathryn A Walker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1447671235 PECOS PAC ID: 7911139332 Enrollment ID: I20140416001973 |
| Provider Name | Joseph Hime |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528324811 PECOS PAC ID: 8123337201 Enrollment ID: I20170112002693 |
| Provider Name | Audrey M Hime |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437425949 PECOS PAC ID: 3870801939 Enrollment ID: I20170130000545 |
| Provider Name | Michelle Elizabeth Farrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861053472 PECOS PAC ID: 0840527800 Enrollment ID: I20190813003812 |
| Provider Name | Anne Landry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235479411 PECOS PAC ID: 0446673362 Enrollment ID: I20200710002937 |
| Provider Name | Natalie Grace Wigle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710522636 PECOS PAC ID: 6103242029 Enrollment ID: I20200821001581 |
| Provider Name | Shanae Love Pietrzycki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114510484 PECOS PAC ID: 5799188959 Enrollment ID: I20210726001553 |
| Provider Name | Jessica Dolan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467025619 PECOS PAC ID: 5395143812 Enrollment ID: I20211027000259 |
| Provider Name | Dennis Dolan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083773311 PECOS PAC ID: 4385748623 Enrollment ID: I20211129000827 |
| Provider Name | Deborah Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033520580 PECOS PAC ID: 2365660263 Enrollment ID: I20220210000668 |
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