Provider Demographics
NPI:1750957445
Name:STORMS, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:STORMS
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 1:7418 NORRIS FWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4219
Mailing Address - Country:US
Mailing Address - Phone:865-377-8560
Mailing Address - Fax:
Practice Address - Street 1:7418 NORRIS FWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-4219
Practice Address - Country:US
Practice Address - Phone:865-377-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist