Individual
KELLY FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2000 BROOKSIDE DR FL 7, KINGSPORT, TN 37660-4627
(423) 857-7011
(423) 857-7018
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024173176
VA
363LF0000X
Family Nurse Practitioner
20561
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629442694
—
VA
Enumeration date
11/13/2015
Last updated
01/05/2026
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