Provider Demographics
NPI:1730182122
Name:MARTIN, CATHERINE LYNN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CUMBERLAND ST W
Mailing Address - Street 2:
Mailing Address - City:COWAN
Mailing Address - State:TN
Mailing Address - Zip Code:37318-3107
Mailing Address - Country:US
Mailing Address - Phone:931-598-5648
Mailing Address - Fax:931-598-9984
Practice Address - Street 1:1314 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2336
Practice Address - Country:US
Practice Address - Phone:931-598-5648
Practice Address - Fax:931-598-9984
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPA1155OtherLICENSE NUMBER
TNPA1155OtherLICENSE NUMBER
TNPA1155OtherLICENSE NUMBER
TN3339710Medicare ID - Type UnspecifiedMEDICARE NUMBER
TN3380640Medicaid