Organization
KINGSPORT ANESTHESIA ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
999 EXECUTIVE PARK BLVD, SUITE 100, KINGSPORT, TN 37660-4632
(423) 247-2022
(423) 247-2027
Mailing address
1A BURTON HILLS BLVD, ATTN: PROVIDER ENROLLMENT, NASHVILLE, TN 37215-6187
(615) 240-3809
(615) 234-1809
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
01/31/2017
Last updated
01/31/2017
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