Provider Demographics
NPI:1306446133
Name:DESROSIERS, KAITLIN M (FNP-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:M
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY STE C460
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1587
Mailing Address - Country:US
Mailing Address - Phone:865-546-9246
Mailing Address - Fax:865-523-6466
Practice Address - Street 1:1932 ALCOA HWY STE C460
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1587
Practice Address - Country:US
Practice Address - Phone:865-546-9246
Practice Address - Fax:865-523-6466
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN26253207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology