Healthcare Provider Details

I. General information

NPI: 1841330370
Provider Name (Legal Business Name): KATHY GAIL GIFFORD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

1295 AILOR GAP RD
LUTTRELL TN
37779-2217
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5437
  • Fax: 865-215-5430
Mailing address:
  • Phone: 865-215-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN0000046928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: