TennCare Provider Registration Portal

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Provider information entered here will be submitted to CAQH to collect the information needed by TennCare for assigning a Medicaid ID.
Make sure to click SUBMIT once all information has been entered. CAQH ProView: https://proview.caqh.org/Login

PROVIDERS: Please review the Electronic Registration

Personal Information
* First Name
Middle Name
* Last Name
* Birth Date Calendar Icon
Professional Identification
* Provider Type
* Primary Practice State
* Provider NPI
* License Number
* License State
Credentialing Contact Information
* Address
Address 2
* City
* State
* Zip (First 5)
Ext Zip (Last 4)
* Phone No
Phone Extension
* E-mail
* Confirm E-mail