Provider Demographics
NPI:1598145138
Name:KELLY, RACHEL (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1204 N HOUSTON LEVEE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6687
Mailing Address - Country:US
Mailing Address - Phone:901-421-5000
Mailing Address - Fax:901-572-1241
Practice Address - Street 1:1204 N HOUSTON LEVEE RD STE 114
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6687
Practice Address - Country:US
Practice Address - Phone:901-421-5000
Practice Address - Fax:901-572-1241
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-128853363L00000X
TN32365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner