Provider Demographics
NPI:1982898193
Name:YOST, KRISTEN NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:YOST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:FUGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7459
Practice Address - Country:US
Practice Address - Phone:423-844-5100
Practice Address - Fax:423-844-5109
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202069207R00000X
KY03157207R00000X
TN2383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100076500Medicaid
KY0994614Medicare PIN
TN103I112904Medicare PIN
KY7100076500Medicaid