Provider Demographics
NPI:1043255896
Name:ROWLAND, KELLEY NICOLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:NICOLE
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7822 GLEASON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6851
Mailing Address - Country:US
Mailing Address - Phone:865-694-9626
Mailing Address - Fax:
Practice Address - Street 1:127 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6345
Practice Address - Country:US
Practice Address - Phone:865-425-9601
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer