Provider Demographics
NPI:1003268053
Name:GABY, KELLIE R (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:R
Last Name:GABY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:M
Other - Last Name:RIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:405 BMH PHYSICIANS OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5807
Practice Address - Country:US
Practice Address - Phone:865-238-6430
Practice Address - Fax:865-238-6444
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022882Medicaid