Provider Demographics
NPI:1659366573
Name:MCCOLL, WILLIAM D (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:MCCOLL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9531367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
261962OtherANTHEM BCBS
TN3607752Medicaid
WV2603073000Medicaid
KY74299447OtherKY MEDICAID
3046122OtherBLUE SHIELD OF TN
VA8922837Medicaid
00013859OtherNHC CARE ADMINISTRATORS
TN0100OtherJOHN DEERE
TN3607752Medicaid
261962OtherANTHEM BCBS