Provider Demographics
NPI:1154911857
Name:WAYNE, KATHRYN (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3300 WILLIAMS ENTERPRISE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506
Mailing Address - Country:US
Mailing Address - Phone:931-528-9222
Mailing Address - Fax:931-854-0907
Practice Address - Street 1:3300 WILLIAMS ENTERPRISE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-528-9222
Practice Address - Fax:931-854-0907
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN248372163W00000X
TN30328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse