Provider Demographics
NPI:1407275225
Name:ELAM, KRISTEN LOVELADY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LOVELADY
Last Name:ELAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 INTERSTATE DR
Mailing Address - Street 2:STE B
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3190
Mailing Address - Country:US
Mailing Address - Phone:931-728-9000
Mailing Address - Fax:931-728-2726
Practice Address - Street 1:585 INTERSTATE DR
Practice Address - Street 2:STE B
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3190
Practice Address - Country:US
Practice Address - Phone:931-728-9000
Practice Address - Fax:931-728-2726
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18509363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730274Medicaid
TN18509OtherFNP LICENSE
TNME3171559OtherDEA