Provider Demographics
NPI:1417182684
Name:HANOR, CATHERINE RUTH (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RUTH
Last Name:HANOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:KINGSPORT
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7459
Practice Address - Country:US
Practice Address - Phone:423-844-5100
Practice Address - Fax:423-844-5109
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168312363LF0000X
TN14482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV V5473AMedicare PIN
TN103I502813Medicare PIN
VA019581C70Medicare PIN
TN10350I1829Medicare PIN
VAV V5473BMedicare PIN