Healthcare Provider Details

I. General information

NPI: 1992676910
Provider Name (Legal Business Name): KATLYN STAR NEUHAUS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 PRESIDENT PL STE 103
SMYRNA TN
37167-8601
US

IV. Provider business mailing address

2524 TITANS LN
BRENTWOOD TN
37027-3734
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-8788
  • Fax: 615-220-8688
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7281
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: