Provider Demographics
NPI:1992725105
Name:VACHON, KATHARINE C (N P)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:C
Last Name:VACHON
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 CLEAR SKY CT
Mailing Address - Street 2:STE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5951
Mailing Address - Country:US
Mailing Address - Phone:931-802-6058
Mailing Address - Fax:931-802-6059
Practice Address - Street 1:291 CLEAR SKY CT
Practice Address - Street 2:STE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5951
Practice Address - Country:US
Practice Address - Phone:931-802-6058
Practice Address - Fax:931-802-6059
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11796363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517918Medicaid
TN103G726066Medicare PIN