=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124151923
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. KATHERINE MORRISON PETRACEK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 02/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 21ST AVE S SUITE 404
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37212-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-879-2332
-----------------------------------------------------
Fax | 615-454-3649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 FALLING SPRING RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37036-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-879-2332
-----------------------------------------------------
Fax | 615-454-3649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APN 12570
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------