Provider Demographics
NPI:1548859127
Name:PROCTOR, RAMONA PHILLIPS
Entity type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:PHILLIPS
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 TELL MYNATT RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-2628
Mailing Address - Country:US
Mailing Address - Phone:865-206-0772
Mailing Address - Fax:
Practice Address - Street 1:5709 TELL MYNATT RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-2628
Practice Address - Country:US
Practice Address - Phone:865-206-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN093040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty