Provider Demographics
NPI:1477788677
Name:JUSTICE, RONA C (APN)
Entity Type:Individual
Prefix:
First Name:RONA
Middle Name:C
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681789
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1789
Mailing Address - Country:US
Mailing Address - Phone:423-245-3170
Mailing Address - Fax:
Practice Address - Street 1:1700 PINEBROOK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4365
Practice Address - Country:US
Practice Address - Phone:423-245-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513466Medicaid
TN1513466Medicaid
TN10350I2619Medicare PIN