Provider Demographics
NPI:1669957767
Name:HEGINBOTTOM, KATHERINE EMERY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EMERY
Last Name:HEGINBOTTOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-1227
Mailing Address - Country:US
Mailing Address - Phone:931-451-7946
Mailing Address - Fax:931-451-7934
Practice Address - Street 1:2000 RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2370
Practice Address - Country:US
Practice Address - Phone:931-486-4200
Practice Address - Fax:859-281-5150
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044326Medicaid