Provider Demographics
NPI:1881732774
Name:ADAMS, KELLIE NICOLE (BS)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:NICOLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:NICOLE
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:1100 US HIGHWAY 58
Practice Address - Street 2:ADDINGTON HALL
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-431-4370
Practice Address - Fax:276-431-2863
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator