Provider Demographics
NPI:1942678701
Name:HUTTON, KELLY J (NNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:HUTTON
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2021
Mailing Address - Country:US
Mailing Address - Phone:330-716-0813
Mailing Address - Fax:
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:#207
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-342-4660
Practice Address - Fax:615-342-4662
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN176931163W00000X
TN20671363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse