Healthcare Provider Details

I. General information

NPI: 1275965907
Provider Name (Legal Business Name): KATIE N LYONS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE N COLOSIMO CRNA

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

PO BOX 2930
CHATTANOOGA IN
46206-2930
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-8400
  • Fax: 423-602-8401
Mailing address:
  • Phone: 423-602-8400
  • Fax: 423-602-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN180978
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN17909
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: