MEDICARE: MRS. REKHA KADAM FNP

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	163W00000X	Registered Nurse	RN0000147602	TN
2	363LF0000X	Family Nurse Practitioner	APN0000022582	TN

General Provider Information

NPI Number	:	1740719848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REKHA KADAM FNP

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 MED TECH PKWY STE 401
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2372
Country	:	US
Telephone Number	:	423-631-0646
Fax Number	:	423-631-0647

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	06/10/2024

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