Provider Demographics
NPI:1306470042
Name:UPCHURCH, KATHERINE ANNE (MS, ATC, CSCS, LAT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNE
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:MS, ATC, CSCS, LAT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,ATC, CSCS, LAT
Mailing Address - Street 1:6191 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5399
Mailing Address - Country:US
Mailing Address - Phone:901-260-1378
Mailing Address - Fax:
Practice Address - Street 1:6191 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5399
Practice Address - Country:US
Practice Address - Phone:901-260-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1209OtherSTATE OF TENNESSEE DIVISION OF HEALTH RELATED BOARDS