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NPI Code Detail

MEDICARE: KATHERINE MARY CLARK CRNA

MEDICARE: KATHERINE MARY CLARK CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist60722768WA
2367500000XCertified Registered Nurse Anesthetist29557TN

General Provider Information

NPI Number : 1104364231
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MARY CLARK CRNA
Provider Business Mailing Address
First Line : 8913 TOWN AND COUNTRY CIR # 1013
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4931
Country : US
Telephone Number : 253-861-0739
Fax Number :
Provider Business Practice Location Address
First Line : 8913 TOWN AND COUNTRY CIR # 1013
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4931
Country : US
Telephone Number : 253-861-0739
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2017
Last Update Date : 05/25/2021

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Directions to “ KATHERINE MARY CLARK CRNA” Practice Location

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