Provider Demographics
NPI:1356924187
Name:FOX, KATHRYN FAYE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FAYE
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 BERRY FARMS XING STE 210
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8038
Mailing Address - Country:US
Mailing Address - Phone:615-914-0013
Mailing Address - Fax:
Practice Address - Street 1:7020 BERRY FARMS XING STE 210
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8038
Practice Address - Country:US
Practice Address - Phone:615-914-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN116161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ085487Medicaid
TN16299688338OtherGROUP 2 NPI