Provider Demographics
NPI:1316583990
Name:MONGER, KELSEY LEIGHANN (RN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGHANN
Last Name:MONGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEIGHANN
Other - Last Name:HAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2341 MCCALLIE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3231
Mailing Address - Country:US
Mailing Address - Phone:423-648-2725
Mailing Address - Fax:423-624-6355
Practice Address - Street 1:2525 DE SALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN204810163WG0000X
TN26986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice