Provider Demographics
NPI:1679128243
Name:COTTRELL, MISTY DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:COTTRELL
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-381-1509
Practice Address - Street 1:8635 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1612
Practice Address - Country:US
Practice Address - Phone:865-824-0079
Practice Address - Fax:833-908-2101
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055968Medicaid