Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0000026176 | TN |
NPI | 1033763081 |
---|---|
Provider Name | Caitlin Gannon |
First Address | Knoxville, TN 37909-1382 |
Second Address | Knoxville, TN 37919-5968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 11/02/2020 |