Provider Demographics
NPI:1003473372
Name:ROUSE, MARY KATRINA QUIST (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY KATRINA
Middle Name:QUIST
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CLINCH AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2295
Mailing Address - Country:US
Mailing Address - Phone:865-673-8229
Mailing Address - Fax:865-673-8893
Practice Address - Street 1:2100 CLINCH AVE STE 330
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916
Practice Address - Country:US
Practice Address - Phone:865-673-8229
Practice Address - Fax:865-673-8893
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily