Provider Demographics
NPI:1558703793
Name:HUNNICUTT, KATRINA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MICHELLE
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 LORNE LN
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-2246
Mailing Address - Country:US
Mailing Address - Phone:865-215-5370
Mailing Address - Fax:
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000104890163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management