Provider Demographics
NPI:1467164392
Name:KING, KATHERINE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GOODSPRING
Mailing Address - State:TN
Mailing Address - Zip Code:38460-5362
Mailing Address - Country:US
Mailing Address - Phone:931-309-4366
Mailing Address - Fax:
Practice Address - Street 1:1222 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6402
Practice Address - Country:US
Practice Address - Phone:931-490-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2023-07-06
Deactivation Date:2023-06-21
Deactivation Code:
Reactivation Date:2023-07-06
Provider Licenses
StateLicense IDTaxonomies
TN238184163WH1000X
TN33215363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2022137775OtherANCC
TN33215OtherTN BON APRN
TN238184OtherTN BON RN