Provider Demographics
NPI:1376973198
Name:KENNEDY, KELLY LEIGH (ACNP-C, RN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LEIGH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ACNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:5600 BRAINERD ROAD
Mailing Address - Street 2:SUITE B14
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411
Mailing Address - Country:US
Mailing Address - Phone:423-825-4800
Mailing Address - Fax:
Practice Address - Street 1:5600 BRAINERD ROAD
Practice Address - Street 2:SUITE B14
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-825-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12659363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care