Provider Demographics
NPI:1316563455
Name:BEINE, KATHLEEN BARKSDALE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:BARKSDALE
Last Name:BEINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2105
Mailing Address - Country:US
Mailing Address - Phone:423-863-3304
Mailing Address - Fax:
Practice Address - Street 1:4515 BROOKRIDGE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2105
Practice Address - Country:US
Practice Address - Phone:423-863-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine