Individual
KELLY M HARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
2205 PAVILION DR, SUITE 201B, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Mailing address
2205 PAVILION DR, SUITE 201B, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12652
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100023580
—
KY
01
—
P01662016
RR MEDICARE
TN
05
—
Q016582
—
TN
Enumeration date
03/26/2007
Last updated
01/30/2017
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