Provider Demographics
NPI:1275747024
Name:EASTHAM, KATHERINE ELIZABETH (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:501 19TH STREET
Mailing Address - Street 2:SUITE 509
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1853
Mailing Address - Country:US
Mailing Address - Phone:865-524-3208
Mailing Address - Fax:865-522-4322
Practice Address - Street 1:501 19TH STREET
Practice Address - Street 2:SUITE 509
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1853
Practice Address - Country:US
Practice Address - Phone:865-524-3208
Practice Address - Fax:865-522-4322
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84619367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife