Provider Demographics
NPI:1972128080
Name:TATE, KAYLA RAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:TATE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RAE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:101 GLENLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3052
Mailing Address - Country:US
Mailing Address - Phone:865-888-4721
Mailing Address - Fax:865-671-0036
Practice Address - Street 1:2012 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-981-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily