Provider Demographics
NPI:1235529256
Name:STOKES, KELLY MCINTOSH (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MCINTOSH
Last Name:STOKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5910
Mailing Address - Fax:423-778-5915
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C-925
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5910
Practice Address - Fax:423-778-5915
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0115828363LF0000X
TN21713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily