Provider Demographics
NPI:1548402654
Name:CARLSON, KELLY A (APN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MEDICAL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5641
Mailing Address - Country:US
Mailing Address - Phone:865-970-9800
Mailing Address - Fax:
Practice Address - Street 1:2347 JONES BEND RD
Practice Address - Street 2:PENINSULA HOSPITAL
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5213
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13956363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health