Provider Demographics
NPI:1912195512
Name:KELLEY, DIANA EWELINA (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:EWELINA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 MONTHAVEN PARK PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7010
Mailing Address - Country:US
Mailing Address - Phone:480-205-9556
Mailing Address - Fax:
Practice Address - Street 1:224 ORIEL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4910
Practice Address - Country:US
Practice Address - Phone:615-862-7940
Practice Address - Fax:615-880-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000161557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse