Provider Demographics
NPI:1881769305
Name:NUNES, KATHRIN KHATEREH (PAC)
Entity type:Individual
Prefix:
First Name:KATHRIN
Middle Name:KHATEREH
Last Name:NUNES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KATHRIN
Other - Middle Name:
Other - Last Name:VODJDANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6141 SHALLOWFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-899-2700
Mailing Address - Fax:423-899-2703
Practice Address - Street 1:6141 SHALLOWFORD ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-899-2700
Practice Address - Fax:423-899-2703
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3388761Medicare ID - Type Unspecified
P52157Medicare UPIN