Provider Demographics
NPI:1568534428
Name:SCOTT, KELLEY VON (APN)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:VON
Last Name:SCOTT
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 1:6078 FLYNTHILL DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2314
Mailing Address - Country:US
Mailing Address - Phone:901-385-6257
Mailing Address - Fax:
Practice Address - Street 1:3362 S 3RD ST
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-2944
Practice Address - Country:US
Practice Address - Phone:901-271-6300
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509516Medicaid