Healthcare Provider Details

I. General information

NPI: 1376024844
Provider Name (Legal Business Name): KATHRYN LEIGH HECKLE CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6100
  • Fax: 865-342-0100
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN24515
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015017630
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: