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General NPI Number Information
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NPI Number | 1992245401
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Entity Type | Individual
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Provider Name | KELLIE HUMPHREY NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 5221 RAVENS GLN
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City | NASHVILLE
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State | TN
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Zip | 37211-8596
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Country | US
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Telephone | 931-743-3559
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Fax | 615-577-3324
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Provider Business Mailing Address
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Address Line | 1493 ANTHONY WAY
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3558
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Country | US
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Telephone | 931-743-3559
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Fax | 615-577-3324
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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 | 22357
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License Number State | TN
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