Healthcare Provider Details

I. General information

NPI: 1104031343
Provider Name (Legal Business Name): KATHERINE MICHELLE STRACK-GEOGHAGAN RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MICHELLE STRACK

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 DANNAHER WAY
POWELL TN
37849-4029
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-1392
  • Fax: 865-859-1399
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number133V00000X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: