Provider Demographics
NPI:1003353699
Name:WINSTEAD, KELIEA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELIEA
Middle Name:ANN
Last Name:WINSTEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KELIEA
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-0506
Mailing Address - Country:US
Mailing Address - Phone:731-535-3600
Mailing Address - Fax:731-535-3603
Practice Address - Street 1:790 BELL STORE RD
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-7350
Practice Address - Country:US
Practice Address - Phone:731-415-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA3201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ071950Medicaid
TNQ029354Medicaid