Provider Demographics
NPI:1417534991
Name:FOREMAN, MYRNA ALISE (PA-C)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:ALISE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:ALISE
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7323 CHAPMAN HWY STE 140
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6758
Mailing Address - Country:US
Mailing Address - Phone:866-231-0701
Mailing Address - Fax:865-584-6384
Practice Address - Street 1:7323 CHAPMAN HWY STE 140
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6758
Practice Address - Country:US
Practice Address - Phone:866-231-0701
Practice Address - Fax:865-584-6384
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant