Individual
KACIE WILKES POLACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
910 BLACKFORD ST, SUITE 102, CHATTANOOGA, TN 37403-1405
(423) 778-6472
(423) 778-4232
Mailing address
975 E 3RD ST, ATTN: PROVIDER ENROLLMENT, CHATTANOOGA, TN 37403-2147
(423) 778-6472
(423) 778-4232
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN19732
TN
Other
Enumeration date
11/04/2014
Last updated
07/20/2021
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