Provider Demographics
NPI:1962977389
Name:MANLEY, KATHERINE LOUISE (APRN)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:LOUISE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:LOUISE
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:79 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-4580
Mailing Address - Country:US
Mailing Address - Phone:731-635-8189
Mailing Address - Fax:731-635-8121
Practice Address - Street 1:79 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-4580
Practice Address - Country:US
Practice Address - Phone:731-635-8189
Practice Address - Fax:731-635-8121
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24919363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics