Provider Demographics
NPI:1124747605
Name:DIGNIFIED HEALTHCARE
Entity type:Organization
Organization Name:DIGNIFIED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-399-9358
Mailing Address - Street 1:5450 HIGHWAY 153 STE 126
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3791
Mailing Address - Country:US
Mailing Address - Phone:865-201-7035
Mailing Address - Fax:865-761-2726
Practice Address - Street 1:5450 HIGHWAY 153 STE 126
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3791
Practice Address - Country:US
Practice Address - Phone:865-201-7035
Practice Address - Fax:865-761-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty