Provider Demographics
NPI:1851334809
Name:FLAKE, KRISTIN M (NP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:FLAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325S CEDAR AVE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-837-5801
Mailing Address - Fax:423-837-5807
Practice Address - Street 1:325 S CEDAR AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1322
Practice Address - Country:US
Practice Address - Phone:423-837-5801
Practice Address - Fax:423-837-5807
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4104914OtherBCBS OF TENNESSEE
TNP00297360OtherRAILROAD MEDICARE
AL891012590Medicaid
TN4104914OtherBCBS OF TENNESSEE
AL891012590Medicaid