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General NPI Number Information
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NPI Number | 1205612553
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Entity Type | Organization
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Legal Business Name | KT SUPERIOR CARE LLC
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 109 BAILEY LN
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City | ROCKWOOD
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State | TN
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Zip | 37854-3653
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Country | US
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Telephone | 865-296-9226
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BAILEY LN
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City | ROCKWOOD
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State | TN
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Zip | 37854-3653
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Country | US
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Telephone | 865-296-9226
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | KELLIAN SLIKER
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Credential |
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Telephone | 865-296-9226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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