Provider Demographics
NPI:1346650132
Name:KELLEY, MISTY (APN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9275 SARDIS SCOTTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-6447
Mailing Address - Country:US
Mailing Address - Phone:731-549-6058
Mailing Address - Fax:
Practice Address - Street 1:9275 SARDIS SCOTTS HILL RD
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-6447
Practice Address - Country:US
Practice Address - Phone:731-549-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily