Provider Demographics
NPI:1134604226
Name:CHRISTENSEN, KAYLEE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SHADOW PKWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5334
Mailing Address - Country:US
Mailing Address - Phone:865-719-5814
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-5179
Practice Address - Fax:423-778-2108
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734OtherTENNESSEE MEDICAL LICENSE