Provider Demographics
NPI:1184845505
Name:KELLEY, ANGELA DENISE KITCHENS (RN, MSN, GNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE KITCHENS
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN, MSN, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-2367
Mailing Address - Country:US
Mailing Address - Phone:423-892-4289
Mailing Address - Fax:
Practice Address - Street 1:4411 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-2367
Practice Address - Country:US
Practice Address - Phone:423-892-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085412363LG0600X
TNAPN0000018133363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G709374OtherMEDICARE PTAN