MEDICARE: KAILYN RENEE GRIFFEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	278680	TN

General Provider Information

NPI Number	:	1043164205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILYN RENEE GRIFFEY

Provider Business Mailing Address
First Line	:	155 TAZEWELL PIKE
Second Line	:
City	:	LUTTRELL
State	:	TN
Zip	:	37779-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 DICK LONAS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1382
Country	:	US
Telephone Number	:	865-588-0236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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