Provider Demographics
NPI:1134894421
Name:JUSTICE, KATHRYN ELISABETH (FNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELISABETH
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELISABETH
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3207
Mailing Address - Country:US
Mailing Address - Phone:276-525-1693
Mailing Address - Fax:
Practice Address - Street 1:615 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3640
Practice Address - Country:US
Practice Address - Phone:423-989-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30128363LF0000X
VA0024182132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily