Provider Demographics
NPI:1235675943
Name:BARNETT, KELLY C (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:BARNETT
Suffix:
Gender:F
Credentials:NP
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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 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-3628
Practice Address - Fax:423-230-8502
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN22033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035I03741Medicare PIN