Healthcare Provider Details

I. General information

NPI: 1275960205
Provider Name (Legal Business Name): KERRY FOROPOULOS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY ANNE LANCASTER

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 MCCALLIE AVE SUITE 100
CHATTANOOGA TN
37403-2800
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPARTMENT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-4588
  • Fax: 865-342-0103
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000147183
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: