Healthcare Provider Details

I. General information

NPI: 1710496872
Provider Name (Legal Business Name): ROBERT LEWIS KITE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14821 DAYTON PIKE STE B
SALE CREEK TN
37373
US

IV. Provider business mailing address

14821 DAYTON PIKE STE B
SALE CREEK TN
37373-5752
US

V. Phone/Fax

Practice location:
  • Phone: 423-486-9455
  • Fax: 423-486-9458
Mailing address:
  • Phone: 423-486-9455
  • Fax: 423-486-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23251
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN191875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: