Provider Demographics
NPI:1952822355
Name:WHITTED, KELLY JO (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JO
Last Name:WHITTED
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960J MADISON ST STE 296
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8038
Mailing Address - Country:US
Mailing Address - Phone:931-444-5494
Mailing Address - Fax:
Practice Address - Street 1:787 WEATHERLY DR STE 300
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8951
Practice Address - Country:US
Practice Address - Phone:931-444-5494
Practice Address - Fax:855-445-3291
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily