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General NPI Number Information
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NPI Number | 1952671182
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Entity Type | Individual
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Provider Name | KELLI GWYN LITTLE NP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 6130 SHALLOWFORD RD STE 101
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7222
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Country | US
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Telephone | 423-664-4635
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Fax | 423-664-4640
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Provider Business Mailing Address
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Address Line | 6130 SHALLOWFORD RD STE 101
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7222
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Country | US
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Telephone | 423-664-4635
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Fax | 423-664-4640
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0000106383
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16667
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License Number State | TN
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