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General NPI Number Information
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NPI Number | 1194393918
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Entity Type | Individual
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Provider Name | MISS KACI ALLISON OETJEN
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Gender | Female
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 7305 JARNIGAN RD STE 260
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4895
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Country | US
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Telephone | 423-708-5050
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Fax | 423-708-5055
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Provider Business Mailing Address
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Address Line | 310 N STATE OF FRANKLIN RD STE 103
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6063
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Country | US
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Telephone | 423-328-0163
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Fax | 423-491-8109
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10703
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6890
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License Number State | TN
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