KEVIN M. MITCHAM (NPI# 1740663608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740663608 |
| Entity Type | Individual |
| Full Name | KEVIN M. MITCHAM |
| Credential | PA |
| Practice Address |
111 W Stone Dr Suite 310 Kingsport TN 37660-6027 |
| Mailing Address |
105 W Stone Dr Suite 6a Kingsport TN 37660-3365 |
| Practice Telephone | 4234087050 |
| Practice Fax Number | 4234087054 |
| Mailing Telephone | 4234087220 |
| Mailing Fax Number | 4234087405 |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
2796 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2796 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 W STONE DR SUITE 310 |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-6027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740284314 | Robert Northrop | Family Medicine | 111 W Stone Dr, Ste 200, Kingsport, TN 37660-6027 | 2005-06-10 |
| 1720685217 | Shayla Atkins Kilgore | Nurse Practitioner | 111 W Stone Dr, Kingsport, TN 37660-6027 | 2020-10-07 |
| 1356891493 | Heather N Ketron | Registered Nurse | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-10-13 |
| 1063962728 | Amanda A. Cantwell | Nurse Practitioner | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-10-06 |
| 1346693868 | Keressa L. Clark | Nurse Practitioner | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-07-20 |
| 1184077158 | Kayla J Joyce | Nurse Practitioner | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-07-14 |
| 1093165102 | Kathryn A. Harris | Registered Nurse | 111 W Stone Dr, Suite 100, Kingsport, TN 37660-6027 | 2016-06-20 |
| 1609239425 | Courtney L Bowles | Nurse Practitioner | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-03-30 |
| 1598124398 | Wellmont Medical Associates, Inc. | Clinic/Center | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-02-22 |
| 1760848204 | Kenneth S Burnette | Registered Nurse | 111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027 | 2016-01-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396900072 | James Michael Yeager | Physician Assistant | 2050 Meadowview Pkwy, Kingsport, TN 37660-7332 | 2008-07-22 |
| 1164441598 | Wayne Matthew Hostler | Physician Assistant | 2050 Meadowview Pkwy, Kingsport, TN 37660-7332 | 2006-07-18 |
| 1922027358 | Louis E Warnken | Physician Assistant | 2050 Meadowview Pkwy, Kingsport, TN 37660-7332 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558987446 | Caleb Stephens | Physician Assistant | 310 N State of Franklin Rd Ste 101, Johnson City, TN 37604-6063 | 2020-06-17 |
| 1609308246 | Robert Bryan Whisenhunt | Physician Assistant | Po Box 205, Tullahoma, TN 37388-0205 | 2017-04-02 |
| 1841744331 | Jessica Leigh Cochran | Physician Assistant | 188 16th Ave Ste 107, Dayton, TN 37321-1037 | 2016-08-12 |
| 1841690096 | Arun Alex | Physician Assistant | 7277 Charlotte Pike Unit 211, Nashville, TN 37209-5041 | 2014-08-25 |
| 1174932107 | Stephen Steffey | Physician Assistant | 408 N State of Franklin Rd Ste 31, Johnson City, TN 37604-6088 | 2014-08-04 |
| 1932450301 | Martha Pamela Guel | Physician Assistant | 2681 Honey Hill Rd, Knoxville, TN 37924-1159 | 2012-09-26 |
| 1912296468 | Richard Terry Washington Jr. | Physician Assistant | 5108 Singing Hills Dr, Antioch, TN 37013-5694 | 2011-04-05 |
| 1578889549 | Caryn Louise Mohr | Physician Assistant | 1635 Kimbrough Park Pl, Germantown, TN 38138-2306 | 2010-04-14 |
| 1578895546 | Carl H. Harris | Physician Assistant | 6946 Finch Rd, Memphis, TN 38141-8598 | 2010-02-02 |
| 1144463936 | Marcus S. Burns | Physician Assistant | 2010 Church St Ste 700, Nashville, TN 37203-2072 | 2009-04-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.