Provider Demographics
NPI:1831189190
Name:KELLY, JAAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JAAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-691-4850
Mailing Address - Fax:865-694-8018
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-691-4850
Practice Address - Fax:865-694-8018
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3661893Medicaid
TN3734041Medicare PIN
TNP94306Medicare UPIN
TN3661893Medicaid
P00210476Medicare PIN