MEDICARE: KELLI WILLIMON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2952	SC
2	363LF0000X	Family Nurse Practitioner	APN0000017752	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17752	OTHER	TN	FNP LICENSE
2	2952	OTHER	SC	FNP LICENSE
3	1497790554	OTHER	SC	NPI -PERSONAL-
4	195624	OTHER	TN	RN LICENSE

General Provider Information

NPI Number	:	1497790554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI WILLIMON FNP

Provider Business Mailing Address
First Line	:	5141 VIRGINIA WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7572
Country	:	US
Telephone Number	:	615-661-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3047
Country	:	US
Telephone Number	:	615-773-9623
Fax Number	:	615-758-0065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	03/26/2026

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