Provider Demographics
NPI:1437722337
Name:CARDWELL, KATIE LAUREN (CPNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LAUREN
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7693 RHEA COUNTY HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6083
Mailing Address - Country:US
Mailing Address - Phone:423-594-8700
Mailing Address - Fax:
Practice Address - Street 1:5505 CREEKWOOD PARK BLVD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-1201
Practice Address - Country:US
Practice Address - Phone:865-986-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30001363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics