Healthcare Provider Details

I. General information

NPI: 1639347180
Provider Name (Legal Business Name): KATE E ESTELLA-WALTER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 LEE HWY SUITE 600
CHATTANOOGA TN
37421-1799
US

IV. Provider business mailing address

7000 LEE HWY SUITE 600
CHATTANOOGA TN
37421-1799
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-0432
  • Fax: 423-894-0475
Mailing address:
  • Phone: 423-894-0432
  • Fax: 423-894-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13170
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: