Healthcare Provider Details

I. General information

NPI: 1295819175
Provider Name (Legal Business Name): ANDREA KELLEY GORE HAYES APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA KELLEY GORE

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 MEMORIAL DR
WINCHESTER TN
37398-2401
US

IV. Provider business mailing address

83 MEMORIAL DR
WINCHESTER TN
37398-2401
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-2236
  • Fax: 931-967-0158
Mailing address:
  • Phone: 931-962-2236
  • Fax: 931-967-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN8403
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: