MEDICARE: KATELYN RAE KNIGHT PA-C

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
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	5381	TN

General Provider Information

NPI Number	:	1972218998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN RAE KNIGHT PA-C

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-1697
Country	:	US
Telephone Number	:	615-322-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	06/17/2024

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