1982834750 NPI number — KATHERINE MARIE MCLENDON NP

Table of content: CASSANDRA ANDERSEN L.M.P. (NPI 1689074478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982834750 NPI number — KATHERINE MARIE MCLENDON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLENDON
Provider First Name:
KATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982834750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 GOFF MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCMINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110-5549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-397-2438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5736 MANCHESTER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37357-7503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-815-3871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2009

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: 363L00000X , with the licence number:  RN051061 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN0000015638 , 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)

  • Identifier: APN0000015638 . This is a "TENNESSEE LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: RN051061NP . This is a "GEORGIA LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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