Healthcare Provider Details

I. General information

NPI: 1205392651
Provider Name (Legal Business Name): HANNAH RUTH KASULI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH R TIPTON

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5283
US

IV. Provider business mailing address

PO BOX 5777
MARYVILLE TN
37802-5777
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5200
  • Fax:
Mailing address:
  • Phone: 865-246-2104
  • Fax: 865-246-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37836
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: