Provider Demographics
NPI:1689668790
Name:BERTRAM, KATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2493
Mailing Address - Country:US
Mailing Address - Phone:931-783-5999
Mailing Address - Fax:931-783-5898
Practice Address - Street 1:128 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2493
Practice Address - Country:US
Practice Address - Phone:931-783-4600
Practice Address - Fax:931-783-4699
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511233Medicaid
TNPENDINGMedicaid
TN3051927Medicaid
TN3723270Medicaid
TN30519271Medicare PIN
TN3051927Medicaid
TN30519271Medicare PIN