Provider Demographics
NPI:1447624457
Name:WEGRYN, JULIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:WEGRYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:NAMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1819 W CLINCH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2434
Mailing Address - Country:US
Mailing Address - Phone:865-546-5111
Mailing Address - Fax:
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2434
Practice Address - Country:US
Practice Address - Phone:865-546-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-15
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020596Medicaid