Provider Demographics
NPI:1346678125
Name:BORNEFELD, KELLY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BORNEFELD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 NASHVILLE PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7144
Mailing Address - Country:US
Mailing Address - Phone:615-451-5192
Mailing Address - Fax:
Practice Address - Street 1:225 BIG STATION CAMP BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8466
Practice Address - Country:US
Practice Address - Phone:615-328-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily