Healthcare Provider Details

I. General information

NPI: 1922963867
Provider Name (Legal Business Name): CHRISTINA TENEAL KELLEY RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 JOPPA RD
WALLING TN
38587-5033
US

IV. Provider business mailing address

102 S SPRING ST
SPARTA TN
38583-1827
US

V. Phone/Fax

Practice location:
  • Phone: 931-418-0567
  • Fax:
Mailing address:
  • Phone: 931-418-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3904
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: