Provider Demographics
NPI:1285832725
Name:BENTLEY-KNOWLES, KATHERINE E (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BENTLEY-KNOWLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5831
Mailing Address - Country:US
Mailing Address - Phone:865-724-1544
Mailing Address - Fax:865-724-1545
Practice Address - Street 1:347 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5831
Practice Address - Country:US
Practice Address - Phone:865-724-1544
Practice Address - Fax:865-724-1545
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN2010010654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524567Medicaid