Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1255848842 |
---|---|
Provider Name | Kristie M Anderson |
First Address | Tracy City, TN 37387-5219 |
Second Address | Monteagle, TN 37356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2018 |
Last Update Date | 04/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9319247823 | PHONE NUMBER (01) | TN |