Provider Demographics
NPI:1285265421
Name:WADE, KATIE DANIELLE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:DANIELLE
Last Name:WADE
Suffix:
Gender:F
Credentials:MSN, 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 1:7161 LEE HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8604
Mailing Address - Country:US
Mailing Address - Phone:423-708-8670
Mailing Address - Fax:
Practice Address - Street 1:7161 LEE HWY STE 400
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8604
Practice Address - Country:US
Practice Address - Phone:423-708-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29727363LP0808X, 363LP0808X
TN241383363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty