Healthcare Provider Details

I. General information

NPI: 1053711689
Provider Name (Legal Business Name): REAGAN KITTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8731 RUTLEDGE PIKE
RUTLEDGE TN
37861-3112
US

IV. Provider business mailing address

6328 MCMILLAN CREEK DR
KNOXVILLE TN
37924-5504
US

V. Phone/Fax

Practice location:
  • Phone: 865-828-5595
  • Fax:
Mailing address:
  • Phone: 423-991-4915
  • Fax: 423-374-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: