Healthcare Provider Details

I. General information

NPI: 1548893472
Provider Name (Legal Business Name): CAROLINE KELLY PIGFORD DNP, AGACNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE KELLY BACON DNP, AGACNP-BC, APRN

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N OCOEE ST
CLEVELAND TN
37311-3850
US

IV. Provider business mailing address

2380 N OCOEE ST
CLEVELAND TN
37311-3850
US

V. Phone/Fax

Practice location:
  • Phone: 423-203-1606
  • Fax: 423-203-1606
Mailing address:
  • Phone: 423-203-1606
  • Fax: 423-203-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number27189
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number27189
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: