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General NPI Number Information
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NPI Number | 1629442694
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Entity Type | Individual
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Provider Name | KELLY FUGATE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2000 BROOKSIDE DR FL 7
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City | KINGSPORT
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State | TN
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Zip | 37660-4627
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Country | US
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Telephone | 423-857-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024173176
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20561
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License Number State | TN
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