Provider Demographics
NPI:1265991517
Name:MARVEL, KAYLEY GRACE
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:GRACE
Last Name:MARVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 VOLKSWAGEN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1761
Mailing Address - Country:US
Mailing Address - Phone:253-403-2938
Mailing Address - Fax:253-403-2968
Practice Address - Street 1:7380 VOLKSWAGEN DR STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1761
Practice Address - Country:US
Practice Address - Phone:253-403-2938
Practice Address - Fax:253-403-2968
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine