Provider Demographics
NPI:1184648966
Name:MCLAIN, M. KATHRYN B (FNP)
Entity Type:Individual
Prefix:
First Name:M. KATHRYN
Middle Name:B
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 3W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-5583
Practice Address - Fax:423-844-5588
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN336691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN007785992Medicaid
TN007785992Medicaid
TN10350I0902Medicare PIN
TNS84158Medicare UPIN
TN39034411Medicare PIN