Provider Demographics
NPI:1700118411
Name:KAMAR, JONATHAN SHREVE (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SHREVE
Last Name:KAMAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 TOPSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-5505
Mailing Address - Country:US
Mailing Address - Phone:865-970-7747
Mailing Address - Fax:865-681-2266
Practice Address - Street 1:1214 TOPSIDE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5505
Practice Address - Country:US
Practice Address - Phone:865-970-7747
Practice Address - Fax:865-681-2266
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant