Provider Demographics
NPI:1437557469
Name:GREENE, KAITLIN A (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:A
Other - Last Name:NAPIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:11130 KINGSTON PIKE
Practice Address - Street 2:SUITE 7 & 8
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2865
Practice Address - Country:US
Practice Address - Phone:865-675-1953
Practice Address - Fax:865-675-0877
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant