Healthcare Provider Details

I. General information

NPI: 1518154566
Provider Name (Legal Business Name): KELLY NOEL OWNBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NOEL KING M.D.

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 ELLIS AVE
MARYVILLE TN
37804-5823
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5377
  • Fax: 865-980-5376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD42827
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: