Provider Demographics
NPI:1811527609
Name:MCKAMEY, KRISTIN R (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:MCKAMEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 SUSANNAH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1765
Mailing Address - Country:US
Mailing Address - Phone:423-434-6677
Mailing Address - Fax:
Practice Address - Street 1:2408 SUSANNAH ST STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1765
Practice Address - Country:US
Practice Address - Phone:423-434-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27147363LF0000X, 207QA0401X
TN203809163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No163WH1000XNursing Service ProvidersRegistered NurseHospice