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General NPI Number Information
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NPI Number | 1679539092
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Entity Type | Individual
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Provider Name | KELLY LEIGH PHILLIPS APRN-BC, FNP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 2501 CITICO AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1127
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Country | US
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Telephone | 423-697-2000
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Fax | 423-697-3510
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Provider Business Mailing Address
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Address Line | 8435 HERON CIR
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City | OOLTEWAH
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State | TN
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Zip | 37363-9283
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Country | US
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Telephone | 423-344-4126
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000007169
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License Number State | TN
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