Provider Demographics
NPI:1770378895
Name:VINSON, KATHERINE KELLY (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:KELLY
Last Name:VINSON
Suffix:
Gender:
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0811
Mailing Address - Country:US
Mailing Address - Phone:731-438-5133
Mailing Address - Fax:
Practice Address - Street 1:815 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2201
Practice Address - Country:US
Practice Address - Phone:731-438-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94434163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator