Healthcare Provider Details

I. General information

NPI: 1821336611
Provider Name (Legal Business Name): KATIE INGRAM WILLARD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LANGLAND ST
KNOXVILLE TN
37915-1415
US

IV. Provider business mailing address

220 LANGLAND ST
KNOXVILLE TN
37915-1415
US

V. Phone/Fax

Practice location:
  • Phone: 865-594-5078
  • Fax: 865-594-3921
Mailing address:
  • Phone: 865-594-5078
  • Fax: 865-594-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000016710
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: