Healthcare Provider Details

I. General information

NPI: 1497790554
Provider Name (Legal Business Name): KELLI WILLIMON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 N MOUNT JULIET RD
MT JULIET TN
37122-3047
US

IV. Provider business mailing address

5141 VIRGINIA WAY
BRENTWOOD TN
37027-7572
US

V. Phone/Fax

Practice location:
  • Phone: 615-773-9623
  • Fax: 615-758-0065
Mailing address:
  • Phone: 615-661-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2952
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000017752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: