Provider Demographics
NPI:1235665126
Name:MARQUETTE, MARY KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:MARQUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KHAKI
Other - Middle Name:
Other - Last Name:MARQUETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:479-524-9312
Practice Address - Street 1:320 BRISTOL WEST BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8773
Practice Address - Country:US
Practice Address - Phone:423-844-1399
Practice Address - Fax:423-844-1397
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71795207V00000X, 207V00000X
VA0101283149207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200982090AMedicaid
AR266911001Medicaid