Provider Demographics
NPI:1902105117
Name:WALL, SUSAN M (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:WALL
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:601-533-7016
Practice Address - Street 1:4221 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-3508
Practice Address - Country:US
Practice Address - Phone:865-392-7264
Practice Address - Fax:865-378-8482
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN0000164256163W00000X
TN18079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse