Healthcare Provider Details

I. General information

NPI: 1417861444
Provider Name (Legal Business Name): KELLY HIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR STE 200
CHATTANOOGA TN
37404-1130
US

IV. Provider business mailing address

605 GLENWOOD DR STE 200
CHATTANOOGA TN
37404-1130
US

V. Phone/Fax

Practice location:
  • Phone: 423-315-1869
  • Fax:
Mailing address:
  • Phone: 423-315-1869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number194985
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: