Provider Demographics
NPI:1699195099
Name:WOLFE, KELLI CHAMBERLAIN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:CHAMBERLAIN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HUXLEY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3197
Mailing Address - Country:US
Mailing Address - Phone:865-691-3335
Mailing Address - Fax:865-691-3310
Practice Address - Street 1:125 HUXLEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3197
Practice Address - Country:US
Practice Address - Phone:865-691-3335
Practice Address - Fax:865-691-3310
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174387163W00000X
TN18565363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse