Provider Demographics
NPI:1528194529
Name:RITTER, KELLY RENAE (NA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RENAE
Last Name:RITTER
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 PARKHURST RD
Mailing Address - Street 2:
Mailing Address - City:RED BOILING SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37150-3049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 HWY 52 BYPASS EAST
Practice Address - Street 2:TN DEPT OF HEALTH
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083
Practice Address - Country:US
Practice Address - Phone:615-666-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide