Healthcare Provider Details

I. General information

NPI: 1992725105
Provider Name (Legal Business Name): KATHARINE C VACHON N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 CLEAR SKY CT STE B
CLARKSVILLE TN
37043-5951
US

IV. Provider business mailing address

291 CLEAR SKY CT STE B
CLARKSVILLE TN
37043-5951
US

V. Phone/Fax

Practice location:
  • Phone: 931-802-6058
  • Fax: 931-802-6059
Mailing address:
  • Phone: 931-802-6058
  • Fax: 931-802-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN11796
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: