Healthcare Provider Details

I. General information

NPI: 1700747821
Provider Name (Legal Business Name): VITAL PATH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 S PITTSBURG MOUNTAIN RD
SOUTH PITTSBURG TN
37380-6191
US

IV. Provider business mailing address

4495 S PITTSBURG MOUNTAIN RD
SOUTH PITTSBURG TN
37380-6191
US

V. Phone/Fax

Practice location:
  • Phone: 423-883-2262
  • Fax:
Mailing address:
  • Phone: 423-883-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MICHELLE FLAKE
Title or Position: NURSE PRACTITIONER
Credential: APRN, FNP-BC
Phone: 423-883-2262