MEDICARE: KATRINA MARIE GILL PA

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
1	363A00000X	Physician Assistant	927	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508867706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MARIE GILL PA

Provider Business Mailing Address
First Line	:	1616 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3100
Country	:	US
Telephone Number	:	615-449-0990
Fax Number	:	615-449-0970

Provider Business Practice Location Address
First Line	:	1616 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3100
Country	:	US
Telephone Number	:	615-449-0990
Fax Number	:	615-449-0970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/13/2007

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Directions to “ KATRINA MARIE GILL PA” Practice Location

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