Healthcare Provider Details

I. General information

NPI: 1982175501
Provider Name (Legal Business Name): PAMMELA MARIE POORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 PAVILION DR STE 110
KINGSPORT TN
37660-4651
US

IV. Provider business mailing address

2204 PAVILION DR STE 110
KINGSPORT TN
37660-4651
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-2369
  • Fax: 423-224-2368
Mailing address:
  • Phone: 423-224-2369
  • Fax: 423-224-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24993
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: