Individual ProviderRyan Keith HairellNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2018 Clinch Ave, Knoxville, TN 37916-2301(865) 541-8266(865) 541-8000PECOS EnrollmentBased on the most recent information from CMS, provider Ryan Keith Hairell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1366117822Provider TypeIndividualFull NameHairell, Ryan KeithGenderMaleSole ProprietorNoEnumeration Date8/16/2021Last Updated2/14/2025Contact InformationPractice LocationPractice Address2018 Clinch Ave, Knoxville, TN 37916-2301Phone(865) 541-8266Fax(865) 541-8553Mailing LocationMailing AddressPO Box 15010, Knoxville, TN 37901-5010Phone(865) 541-8000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense29891TennesseeProvider IdentifiersIDDescriptionIssuerIDQ074599DescriptionMedicaidIssuerUnlistedTennessee