Provider Demographics
NPI:1508945817
Name:KLENA, KRISTY VANDIVER (NP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:VANDIVER
Last Name:KLENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:S
Other - Last Name:VANDIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:2240 SUTHERLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2333
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:865-588-8841
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily