Healthcare Provider Details

I. General information

NPI: 1083783096
Provider Name (Legal Business Name): KATHRYN E JALOVEC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH STREET
CLARKSVILLE TN
37040
US

IV. Provider business mailing address

511 8TH STREET
CLARKSVILLE TN
37040
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46974
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number232913
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: