MEDICARE: MARILYN M ACREE REGISTERED NURSE RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001101621	VA
2	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	0001101621	VA

General Provider Information

NPI Number	:	1750394854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN M ACREE REGISTERED NURSE RNC

Provider Business Mailing Address
First Line	:	PO BOX 9054
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-9054
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3696

Provider Business Practice Location Address
First Line	:	1570 WAVERLY RD
Second Line	:	HOLSTON COUNSELING
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2523
Country	:	US
Telephone Number	:	423-224-1300
Fax Number	:	423-224-1375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/11/2025

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