Provider Demographics
NPI:1891944765
Name:DYER, KRISTINE JOAN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:JOAN
Last Name:DYER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 PIPERTON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3168
Mailing Address - Country:US
Mailing Address - Phone:865-898-0347
Mailing Address - Fax:
Practice Address - Street 1:8045 ROANE MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748
Practice Address - Country:US
Practice Address - Phone:865-316-3375
Practice Address - Fax:865-316-3734
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512807Medicaid
3342423Medicare PIN