Healthcare Provider Details

I. General information

NPI: 1962807107
Provider Name (Legal Business Name): ELIZABETH KAYE DUPREE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

7019 MAPLE LEAF LN
HARRISON TN
37341-3995
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8054
  • Fax: 423-209-8051
Mailing address:
  • Phone: 423-313-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000170797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: