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NPI Code Detail

MEDICARE: KATRINA LEANN LASTER

MEDICARE: KATRINA LEANN LASTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1275682825
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA LEANN LASTER
Provider Business Mailing Address
First Line : 200 TECH CENTER DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37912-2747
Country : US
Telephone Number : 865-637-9711
Fax Number : 865-637-4362
Provider Business Practice Location Address
First Line : 600 ARTHUR ST
Second Line :
City : KNOXVILLE
State : TN
Zip : 37921-6405
Country : US
Telephone Number : 865-637-9711
Fax Number : 865-637-4362
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 03/02/2021

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Directions to “ KATRINA LEANN LASTER ” Practice Location

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