Individual
MS. KATHRYN BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2033 MEADOWVIEW LN, STE 200, KINGSPORT, TN 37660-7569
(423) 857-2260
(423) 857-2261
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
0024070828
VA
363LP0200X
Pediatric Nurse Practitioner
Primary
APN 6139
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007787031
—
VA
05
—
3348978
—
TN
05
—
PENDING
—
TN
Enumeration date
05/24/2005
Last updated
08/27/2009
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