Provider Demographics
NPI:1922556679
Name:COUSINS, KATHRYN LEA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LEA
Last Name:COUSINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 CROSS PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4564
Mailing Address - Country:US
Mailing Address - Phone:865-632-5900
Mailing Address - Fax:
Practice Address - Street 1:9125 CROSS PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4564
Practice Address - Country:US
Practice Address - Phone:865-632-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023940Medicaid