Provider Demographics
NPI:1366444333
Name:GARDNER, KATHERINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:319 ERIN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6202
Mailing Address - Country:US
Mailing Address - Phone:865-588-0880
Mailing Address - Fax:865-584-3111
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:BOX U109
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9220
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24141207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3036004OtherBLUE CROSS
TN3801628Medicaid
KY64924137Medicaid
3801628Medicare ID - Type Unspecified
TN3801628Medicaid