Provider Demographics
NPI:1124151923
Name:PETRACEK, KATHERINE MORRISON
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MORRISON
Last Name:PETRACEK
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 1:225 FALLING SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-1300
Mailing Address - Country:US
Mailing Address - Phone:615-879-2332
Mailing Address - Fax:615-454-3649
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:SUITE 404
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-879-2332
Practice Address - Fax:615-454-3649
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 12570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health