Basic Information
| Provider Information | |||||||||
| NPI: | 1922027358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNKEN | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 MEADOWVIEW PKWY | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376607332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232305000 | ||||||||
| FaxNumber: | 4232305010 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 MEADOWVIEW PKWY | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376607332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232305000 | ||||||||
| FaxNumber: | 4232305010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 1068 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3661901 | 01 | TN | MEDICARE | OTHER | 4068901 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 3661901 | 05 | TN | MEDICAID |