MEDICARE: MRS. BONNIE L MESSERSCHMIDT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	6704	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TN0103	OTHER	TN	JOHN DEER HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619935210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE L MESSERSCHMIDT NP

Provider Business Mailing Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 100
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4005
Country	:	US
Telephone Number	:	423-246-6445
Fax Number	:	423-246-8240

Provider Business Practice Location Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 100
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4005
Country	:	US
Telephone Number	:	423-246-6445
Fax Number	:	423-246-8240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	09/28/2013

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