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General NPI Number Information
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NPI Number | 1477378891
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Entity Type | Individual
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Provider Name | KELLIE DIANNE AZOR AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 195 WHITE OAK RD STE 400
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City | DAYTON
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State | TN
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Zip | 37321-2238
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Country | US
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Telephone | 423-778-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 4922 MCDONALD RD
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City | MC DONALD
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State | TN
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Zip | 37353-4057
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Country | US
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Telephone | 615-812-1687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 37247
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 37247
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License Number State | TN
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