Healthcare Provider Details

I. General information

NPI: 1679417687
Provider Name (Legal Business Name): CHELSE BREANN KELLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

674 WOODLAND FOX LN W
CORDOVA TN
38018-1147
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-7000
  • Fax:
Mailing address:
  • Phone: 901-672-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number41845
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: