Healthcare Provider Details

I. General information

NPI: 1669957767
Provider Name (Legal Business Name): KATHERINE EMERY HEGINBOTTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RESERVE BLVD
SPRING HILL TN
37174-2370
US

IV. Provider business mailing address

PO BOX 1227
SPRING HILL TN
37174-1227
US

V. Phone/Fax

Practice location:
  • Phone: 931-486-4200
  • Fax: 859-281-5150
Mailing address:
  • Phone: 931-451-7946
  • Fax: 931-451-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24771
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: