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Contact Information

KELLY M HARE, F.N.P.
2205 PAVILION DR
SUITE 201B
KINGSPORT, TN37660-4641
 Phone: 423-857-7650
 Fax: 423-857-7655
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for KELLY M HARE · (Female)

NPI Number 1821115676
Status Active
Credentials F.N.P.
Entity Individual
Enumeration date 03/26/2007
Last updated 01/30/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 12652
  • KY Medicaid 7100023580
  • TN Medicaid Q016582
  • TN Other P01662016 RR MEDICARE
Hospital affiliation(s)
  • INDIAN PATH MEDICAL CENTER - (Acute Care)
    2000 BROOKSIDE DR
    KINGSPORT, TN 37660
  • WELLMONT BRISTOL REGIONAL MEDICAL CENTER - (Acute Care)
    ONE MEDICAL PARK BLVD
    BRISTOL, TN 37620
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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