Provider Demographics
NPI:1578751582
Name:PIPER, KELLY J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:PIPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:GIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:423 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5640
Mailing Address - Country:US
Mailing Address - Phone:865-271-6600
Mailing Address - Fax:865-271-6601
Practice Address - Street 1:423 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5640
Practice Address - Country:US
Practice Address - Phone:865-271-6600
Practice Address - Fax:865-271-6601
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003039363AM0700X
TN2169363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531893Medicaid
TN103I979563Medicare PIN