Basic Information
| Provider Information | |||||||||
| NPI: | 1043370687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUGGER | ||||||||
| FirstName: | KERMIT | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1497 W ELK AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376432895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235428929 | ||||||||
| FaxNumber: | 4235428621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1497 W ELK AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376432895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235428929 | ||||||||
| FaxNumber: | 4235428621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024169795 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN0000007383 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 7383 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1043370687 | 05 | VA | MEDICAID | 3343836 | 05 | TN | MEDICAID |