Provider Demographics
NPI:1588010185
Name:FLATT, KATASHA RAE
Entity Type:Individual
Prefix:MRS
First Name:KATASHA
Middle Name:RAE
Last Name:FLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATASHA
Other - Middle Name:RAE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:355 BMH PHYSICIANS OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5820
Practice Address - Country:US
Practice Address - Phone:865-980-5060
Practice Address - Fax:865-980-5066
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26785363LF0000X
SC20144A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055387Medicaid