1427247535 NPI number — MRS. KATHARINE KELLIE MEDICUS LCSW

Table of content: MRS. KATHARINE KELLIE MEDICUS LCSW (NPI 1427247535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427247535 NPI number — MRS. KATHARINE KELLIE MEDICUS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDICUS
Provider First Name:
KATHARINE
Provider Middle Name:
KELLIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANCIS
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
KELLIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427247535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 E OKLAHOMA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37917-6332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-637-6793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 E SCOTT AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37917-6362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-621-7644
Provider Business Practice Location Address Fax Number:
865-329-9433
Provider Enumeration Date:
10/15/2007

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: 1041C0700X , with the licence number:  4561 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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