Provider Demographics
NPI:1720353782
Name:DAGGETT, KATIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 US 51 SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019
Mailing Address - Country:US
Mailing Address - Phone:901-313-9274
Mailing Address - Fax:
Practice Address - Street 1:1618 US 51 SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019
Practice Address - Country:US
Practice Address - Phone:901-313-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2116363A00000X
MSPA00181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical