Provider Demographics
NPI:1295431203
Name:GAY, KATIE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:GAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 ISABELLA LANE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-768-8021
Mailing Address - Fax:615-768-8022
Practice Address - Street 1:880 ISABELLA LANE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-768-8021
Practice Address - Fax:615-768-8022
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN5414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant