Provider Demographics
NPI:1225506272
Name:KELLOGG, DARLENE (CNA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8489 HUNTER HILL CT
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4811
Mailing Address - Country:US
Mailing Address - Phone:423-774-9974
Mailing Address - Fax:423-553-8237
Practice Address - Street 1:8489 HUNTER HILL CT
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4811
Practice Address - Country:US
Practice Address - Phone:423-774-9974
Practice Address - Fax:423-553-8237
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00034642376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide