Provider Demographics
NPI:1710453436
Name:GAYLER, KELLY (NP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GAYLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 GUNBARREL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7162
Mailing Address - Country:US
Mailing Address - Phone:423-778-8870
Mailing Address - Fax:423-778-8871
Practice Address - Street 1:1751 GUNBARREL RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7162
Practice Address - Country:US
Practice Address - Phone:423-778-8870
Practice Address - Fax:423-778-8871
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25024363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner