Healthcare Provider Details

I. General information

NPI: 1851437685
Provider Name (Legal Business Name): KATHRYN JEFFRIES ABBOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5132
US

IV. Provider business mailing address

1363 W HUNT RD
MARYVILLE TN
37801-1791
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-4582
  • Fax: 865-983-4574
Mailing address:
  • Phone: 865-983-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000055405
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: