Provider Demographics
NPI:1760931380
Name:GREENWELL, KATHERINE CLAYTON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CLAYTON
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:927 N JAMES CAMPBELL BLVD
Mailing Address - Street 2:#105
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2753
Mailing Address - Country:US
Mailing Address - Phone:931-388-5114
Mailing Address - Fax:
Practice Address - Street 1:927 N JAMES CAMPBELL BLVD
Practice Address - Street 2:#105
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2753
Practice Address - Country:US
Practice Address - Phone:931-388-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant