Provider Demographics
NPI:1306385927
Name:KELLEY, LINDSEY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:KELLEY
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11217 WEST POINT DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-675-4342
Mailing Address - Fax:865-675-4343
Practice Address - Street 1:11217 WEST POINT DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-675-4342
Practice Address - Fax:865-675-4343
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000176179163W00000X
TNAPN0000021789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027736Medicaid