Basic Information
Provider Information
NPI: 1770983835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RADER
FirstName: KARI
MiddleName: E.
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 440028
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372440028
CountryCode: US
TelephoneNumber: 8656706199
FaxNumber: 8656706198
Practice Location
Address1: 1926 ALCOA HWY
Address2: STE 130
City: KNOXVILLE
State: TN
PostalCode: 379201545
CountryCode: US
TelephoneNumber: 8653059040
FaxNumber: 8653056188
Other Information
ProviderEnumerationDate: 08/26/2014
LastUpdateDate: 08/26/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SF0001X19011TNY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health

No ID Information.


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