1215136544 NPI number — KATIE F. CAMENZIND PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215136544 NPI number — KATIE F. CAMENZIND PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMENZIND
Provider First Name:
KATIE
Provider Middle Name:
F.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZPATRICK
Provider Other First Name:
KATIE
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215136544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 DREAM VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLS RIVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28759-7671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-386-8329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 WESTFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-264-2400
Provider Business Practice Location Address Fax Number:
865-588-6406
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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