Basic Information
| Provider Information | |||||||||
| NPI: | 1861984395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOACHIM | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6108 KINGSTON PIKE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656359464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9325 S NORTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379226548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653307425 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | F05180723 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | NP95009238 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 812324 | 01 | NV | NEVADA BOARD OF NURSING | OTHER | 26731 | 01 | TN | STATE OF TENNESSEE | OTHER | NP95009238 | 01 | CA | CA LICENSE | OTHER |