Active NPI
Kelly J Medlin, LPC
- Professional Counselor
- Kingsport, TN
National Provider Identifier
1104468180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4584
- Practice address
- 2001 E Stonebrook PL
Kingsport, TN 37660-4000 - Phone
- (423) 224-1000
- Fax
- (423) 467-3644
- NPI assigned
- Oct 11, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4584 | TN | Primary |
Addresses
Primary practice location
2001 E Stonebrook PL
Kingsport, TN 37660-4000
Mailing address
1167 Spratlin Park Dr
Gray, TN 37615-6205
Phone (423) 467-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4584 | TN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1104468180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1167 SPRATLIN PARK DR",
"city": "GRAY",
"state": "TN",
"postal_code": "376156205",
"telephone_number": "423-467-3600",
"fax_number": "423-467-3644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 E STONEBROOK PL",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604000",
"telephone_number": "423-224-1000",
"fax_number": "423-467-3644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLIN",
"first_name": "KELLY",
"middle_name": "J",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-11",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "4584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.