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Organization
SMOKEY MOUNTAIN MEDICAL LLC
Active
Organization
SMOKEY MOUNTAIN MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY KINGSLEY APRN (OWNER)
(423) 592-0422
Entity
Organization
Contact information
Practice address
163 PERKINS LN, JACKSBORO, TN 37757-2833
(423) 592-0422
Mailing address
163 PERKINS LN, JACKSBORO, TN 37757-2833
(423) 592-0422
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/21/2024
Last updated
11/05/2024
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