Provider Demographics
NPI:1356091748
Name:WILLIAMSON, KELLIE M (RN)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:EVENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37332-3200
Mailing Address - Country:US
Mailing Address - Phone:423-775-7819
Mailing Address - Fax:423-775-8078
Practice Address - Street 1:344 EAGLE LN
Practice Address - Street 2:
Practice Address - City:EVENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37332-3200
Practice Address - Country:US
Practice Address - Phone:423-775-7819
Practice Address - Fax:423-775-8078
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN141904163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health