Provider Demographics
NPI:1770621013
Name:SLAGLE, PHYLLIS A (RN)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7735 KARNS RD
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-2332
Mailing Address - Country:US
Mailing Address - Phone:865-687-8154
Mailing Address - Fax:
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5071
Practice Address - Fax:865-215-5406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000106078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse