Healthcare Provider Details

I. General information

NPI: 1396576419
Provider Name (Legal Business Name): KATIE ANN MERCER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MERIDIAN BLVD STE 108
FRANKLIN TN
37067-6345
US

IV. Provider business mailing address

2500 PALOMAR CIR APT J1
COLUMBIA TN
38401-1039
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-8809
  • Fax:
Mailing address:
  • Phone: 615-600-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: