Provider Demographics
NPI:1326732793
Name:PSYCHIATRIC CARE OF KINGSPORT PC
Entity Type:Organization
Organization Name:PSYCHIATRIC CARE OF KINGSPORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-392-6502
Mailing Address - Street 1:444 CLINCHFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3859
Mailing Address - Country:US
Mailing Address - Phone:423-392-6502
Mailing Address - Fax:423-392-6504
Practice Address - Street 1:444 CLINCHFIELD ST STE 101
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3859
Practice Address - Country:US
Practice Address - Phone:423-392-6502
Practice Address - Fax:423-392-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty