Healthcare Provider Details

I. General information

NPI: 1003248857
Provider Name (Legal Business Name): ANDREA KATHRYN KOTTMEIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 DOWELL SPRINGS BLVD
KNOXVILLE TN
37909-2454
US

IV. Provider business mailing address

2506 HOLSTON RIVER DR
RUTLEDGE TN
37861-4330
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-5121
  • Fax:
Mailing address:
  • Phone: 865-919-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number161170
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: