Provider Demographics
NPI:1548281785
Name:QUILLEN, LINDA R (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 SUNSET DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8310
Mailing Address - Country:US
Mailing Address - Phone:423-794-3142
Mailing Address - Fax:423-794-3184
Practice Address - Street 1:818 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8310
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6094363LG0600X
TN6094363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902189Medicaid
TN103I509679Medicare PIN