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General NPI Number Information
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NPI Number | 1144731720
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Entity Type | Individual
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Provider Name | KATHERINE MONTOTO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 380 W BROADWAY BLVD STE 130
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City | JEFFERSON CITY
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State | TN
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Zip | 37760-2602
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Country | US
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Telephone | 865-584-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 DICK LONAS RD UNIT 101
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City | KNOXVILLE
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State | TN
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Zip | 37909-1383
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Country | US
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Telephone | 865-584-4747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28820
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9315196
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License Number State | FL
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