Kathryn Backus, NP
Individual provider Active NPI Pediatric Nurse Practitioner · Kingsport, TN
NPI 1508869348 · NPPES record last updated Aug 27, 2009
Key facts
- NPI
- 1508869348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- APN 6139 (TN)
- Practice address
- 2033 Meadowview LN
Ste 200
Kingsport, TN 37660-7569 - Phone
- (423) 857-2260
- Fax
- (423) 857-2261
- NPI assigned
- May 24, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN 6139 | TN | MD | Pediatric Nurse Practitioner |
| 0024070828 | VA | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | APN 6139 | TN | Yes |
| Pediatric Nurse Practitioner | 363LP0200X | 0024070828 | VA |
Addresses
Primary practice location
2033 Meadowview LN
Ste 200
Kingsport, TN 37660-7569
Mailing address
PO Box 9
Kingsport, TN 37662-0009
Phone (423) 857-2066
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007787031 | Medicaid | VA | |
| 3348978 | Medicaid | TN | |
| PENDING | Medicaid | TN |
Other providers in Kingsport, TN
- Avail Southeast Kidney Care LLC
- Bradley S Avans
- Joseph Barron Avery
- Mary Axelrad
- Mark Aziz
- Larry Alan Bacon
- Michael L Bacon
- Claxton Allen Baer
- Beverly Lynn Bailey
- Heather Bailey
All providers in Kingsport, TN · Pediatric Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.