MEDICARE: JUSTIN KINDRICK N.P.

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	143100	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5020737	NC
3	363LF0000X	Family Nurse Practitioner	5020737	NC
4	363L00000X	Nurse Practitioner	16187	TN

General Provider Information

NPI Number	:	1891915047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN KINDRICK N.P.

Provider Business Mailing Address
First Line	:	181 MATHERLY ST
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-1001
Country	:	US
Telephone Number	:	931-484-2727
Fax Number	:	931-484-1670

Provider Business Practice Location Address
First Line	:	42 DOOLEY STREET
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555
Country	:	US
Telephone Number	:	931-707-7117
Fax Number	:

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	01/20/2026

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