Provider Demographics
NPI:1407048473
Name:WHITAKER, KELLEY (RN, APN)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 23RD AVE N
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-277-2429
Mailing Address - Fax:615-320-0240
Practice Address - Street 1:345 23RD AVE N
Practice Address - Street 2:SUITE 401
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-277-2429
Practice Address - Fax:615-320-0240
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11965363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health