Provider Demographics
NPI:1578024873
Name:LILLY, KRISTEN MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:LILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MICHELLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9430 PARK WEST BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4209
Mailing Address - Country:US
Mailing Address - Phone:865-769-4444
Mailing Address - Fax:865-769-4418
Practice Address - Street 1:9430 PARK WEST BLVD STE 320
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4209
Practice Address - Country:US
Practice Address - Phone:865-769-4444
Practice Address - Fax:865-769-4418
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN67946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology