Healthcare Provider Details

I. General information

NPI: 1396039707
Provider Name (Legal Business Name): KELLY NEWELL NAZARY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

IV. Provider business mailing address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-1000
  • Fax: 901-271-4187
Mailing address:
  • Phone: 901-271-1000
  • Fax: 901-271-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number159390
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0311040
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15848
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: