Healthcare Provider Details

I. General information

NPI: 1528194529
Provider Name (Legal Business Name): KELLY RENAE RITTER NA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HWY 52 BYPASS EAST TN DEPT OF HEALTH
LAFAYETTE TN
37083
US

IV. Provider business mailing address

1493 PARKHURST RD
RED BOILING SPRINGS TN
37150-3049
US

V. Phone/Fax

Practice location:
  • Phone: 615-666-2142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: