Provider Demographics
NPI:1740733633
Name:KEITH, ANDRIA MICHELLE (APN)
Entity type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:MICHELLE
Last Name:KEITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:MICHELLE
Other - Last Name:HENNESSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 N CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2704
Mailing Address - Country:US
Mailing Address - Phone:615-597-4395
Mailing Address - Fax:615-597-5075
Practice Address - Street 1:302 N CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2704
Practice Address - Country:US
Practice Address - Phone:615-597-4395
Practice Address - Fax:615-597-5075
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN21466OtherAPN STATE LICENSE NUMBER