Provider Demographics
NPI:1962699314
Name:WILLINGHAM, KATRINA KAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:KAYE
Last Name:WILLINGHAM
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 1:1236 MORELAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5222
Mailing Address - Country:US
Mailing Address - Phone:423-354-1300
Mailing Address - Fax:423-354-1306
Practice Address - Street 1:1236 MORELAND DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-5222
Practice Address - Country:US
Practice Address - Phone:423-354-1300
Practice Address - Fax:423-354-1306
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000063029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse