Healthcare Provider Details

I. General information

NPI: 1497586838
Provider Name (Legal Business Name): KATHERINE MEDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

809 LAMONT ST # AT
JOHNSON CITY TN
37604-5453
US

IV. Provider business mailing address

2175 DAVE BUCK RD
JOHNSON CITY TN
37601-7104
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3061772
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: