Provider Demographics
NPI:1245798107
Name:HYDER, KELLY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:HYDER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 BROOKVALE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4003
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:1665 E ANDREW JOHNSON HWY STE 2
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5826
Practice Address - Country:US
Practice Address - Phone:423-639-0243
Practice Address - Fax:423-639-0628
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily