=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881505535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERESE MICHELE LEE CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3616 NETHERLAND INN RD STE 6
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-7296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-403-3258
-----------------------------------------------------
Fax | 423-295-9626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3616 NETHERLAND INN RD STE 6
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-7296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-403-3258
-----------------------------------------------------
Fax | 423-295-9626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 42895
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------