Healthcare Provider Details

I. General information

NPI: 1437131182
Provider Name (Legal Business Name): KATHRYN M LILLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING RD STE 803
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

104 WOODMONT BLVD SUITE LL-50
NASHVILLE TN
37205-2245
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-3395
  • Fax: 615-386-2197
Mailing address:
  • Phone: 615-386-2300
  • Fax: 615-386-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberRN123204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: