Provider Demographics
NPI:1013493147
Name:GREENWOOD, CATHY A (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:A
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 WINESAP RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2920
Mailing Address - Country:US
Mailing Address - Phone:423-726-2077
Mailing Address - Fax:
Practice Address - Street 1:3136 WINESAP RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2920
Practice Address - Country:US
Practice Address - Phone:423-726-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily