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NPI Code Detail

MEDICARE: MRS. KATIE INGRAM WILLARD CPNP

MEDICARE: MRS. KATIE INGRAM WILLARD CPNP
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
1363LP0200XPediatric Nurse PractitionerAPN0000016710TN

General Provider Information

NPI Number : 1821336611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE INGRAM WILLARD CPNP
Provider Business Mailing Address
First Line : 220 LANGLAND ST
Second Line :
City : KNOXVILLE
State : TN
Zip : 37915-1415
Country : US
Telephone Number : 865-594-5078
Fax Number : 865-594-3921
Provider Business Practice Location Address
First Line : 220 LANGLAND ST
Second Line :
City : KNOXVILLE
State : TN
Zip : 37915-1415
Country : US
Telephone Number : 865-594-5078
Fax Number : 865-594-3921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2013
Last Update Date : 01/29/2013

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