Provider Demographics
NPI:1043370687
Name:DUGGER, KERMIT L (FNP, PMHNP)
Entity type:Individual
Prefix:MR
First Name:KERMIT
Middle Name:L
Last Name:DUGGER
Suffix:
Gender:M
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-8929
Mailing Address - Fax:423-542-8621
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-8929
Practice Address - Fax:423-542-8621
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169795363LF0000X
TNAPN0000007383363LF0000X
TN7383363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043370687Medicaid
TN3343836Medicaid
VAVV4804AMedicare PIN
TN3709285Medicare UPIN
VAC09112Medicare UPIN
TN103I504930Medicare PIN
TN3709285Medicare UPIN
VAC09112Medicare UPIN
TN103I504930Medicare PIN