Provider Demographics
NPI:1770762163
Name:BOSTROM, KATIE CARR (APN, RNC, NNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:CARR
Last Name:BOSTROM
Suffix:
Gender:F
Credentials:APN, RNC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WEST BLUFF ROAD
Mailing Address - Street 2:
Mailing Address - City:CLOUDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:30731
Mailing Address - Country:US
Mailing Address - Phone:423-505-4228
Mailing Address - Fax:
Practice Address - Street 1:2300 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1538
Practice Address - Country:US
Practice Address - Phone:615-342-4660
Practice Address - Fax:615-342-4662
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8053363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care