| Doctor Name: | KATY TILLEY |
| NPI Number: | 1457712424 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 20895 |
| Business Practice Address: | 1206 Highway 411 Vonore, TN - 378852455 |
| Business Phone Number: | 4238847271 |
| Business Fax Number: | 4238843277 |
| Mailing Address: | Po Box 278, MADISONVILLE |
| State: | TN |
| Postal Code: | 373540278 |
| Phone Number: | 4234422622 |
| Fax Number: | 4234425760 |
| NPI Enumeration Date: | 03/17/2016 |
| NPI Last Update Date: | 03/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 20895 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |