Healthcare Provider Details

I. General information

NPI: 1861600801
Provider Name (Legal Business Name): KIRSTEN ANNE KOENNE CDA,RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 FOX RD
KNOXVILLE TN
37922-3383
US

IV. Provider business mailing address

1616 DUNCAN RD
KNOXVILLE TN
37919-8517
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-5231
  • Fax: 865-691-4291
Mailing address:
  • Phone: 865-330-0156
  • Fax: 865-691-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number10582
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: