Healthcare Provider Details

I. General information

NPI: 1487345559
Provider Name (Legal Business Name): MISS KIRI NICOLE HAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MED TECH PKWY STE 201
JOHNSON CITY TN
37604-2365
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-302-3480
  • Fax: 423-722-3009
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: