Provider Demographics
NPI:1003813023
Name:DENEGRI, KATRINA H (GNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:H
Last Name:DENEGRI
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:A
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GNP
Mailing Address - Street 1:PO BOX 820406
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38182-0406
Mailing Address - Country:US
Mailing Address - Phone:901-725-0872
Mailing Address - Fax:901-278-6934
Practice Address - Street 1:1726 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6426
Practice Address - Country:US
Practice Address - Phone:901-725-0872
Practice Address - Fax:901-278-6934
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008186363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908110Medicaid
TNP77563Medicare UPIN
TN3908110Medicaid