Provider Demographics
NPI:1386335131
Name:HANSON, KATLYN (RN)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COSBY
Mailing Address - State:TN
Mailing Address - Zip Code:37722-3442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 PINNACLES WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7308
Practice Address - Country:US
Practice Address - Phone:865-585-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9536242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse