Provider Demographics
NPI:1003248857
Name:KOTTMEIER, ANDREA KATHRYN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHRYN
Last Name:KOTTMEIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 HOLSTON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-4330
Mailing Address - Country:US
Mailing Address - Phone:865-919-5993
Mailing Address - Fax:
Practice Address - Street 1:1311 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2454
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN161170367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered