Provider Demographics
NPI:1194435800
Name:HUBBARD, KASSIDY NICOLE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:NICOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FORT SUMMIT WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2146
Mailing Address - Country:US
Mailing Address - Phone:865-970-9800
Mailing Address - Fax:865-374-2054
Practice Address - Street 1:550 FORT SUMMIT WAY FL 2
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37915-2146
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-374-2054
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000244679163WP0808X
TN33077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN081069Medicaid