Provider Demographics
NPI:1598900656
Name:URRUTY, KENLI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENLI
Middle Name:ANN
Last Name:URRUTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAGNOLIA GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-4265
Mailing Address - Country:US
Mailing Address - Phone:307-620-0151
Mailing Address - Fax:
Practice Address - Street 1:1800 VOLUNTEER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-4522
Practice Address - Country:US
Practice Address - Phone:965-974-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist