Provider Demographics
NPI:1689191264
Name:STERGIOS, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STERGIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 WOODWIND DR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8357
Mailing Address - Country:US
Mailing Address - Phone:423-292-8256
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHWAY 11W
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5810
Practice Address - Country:US
Practice Address - Phone:865-993-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist