Provider Demographics
NPI:1245737162
Name:LITTLE, KELSEY JEAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JEAN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:JEAN
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:221 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3815
Practice Address - Country:US
Practice Address - Phone:423-787-6050
Practice Address - Fax:423-787-6054
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068251Medicaid