Basic Information
| Provider Information | |||||||||
| NPI: | 1316297377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOE | ||||||||
| FirstName: | KAYTHI | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371110640 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5736 MANCHESTER HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373577503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
| FaxNumber: | 9318153876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 162472 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 16947 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.