Provider Demographics
NPI:1538428230
Name:PAINTER, MICHELLE L (NP)
Entity type:Individual
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First Name:MICHELLE
Middle Name:L
Last Name:PAINTER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:3183 W STATE ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1712
Practice Address - Country:US
Practice Address - Phone:423-968-2772
Practice Address - Fax:423-968-1377
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-07-05
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Provider Licenses
StateLicense IDTaxonomies
TN16486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I502854Medicare PIN