MEDICARE: DARLENE KELLOGG CNA

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	376K00000X	Nurse's Aide	00034642	TN

General Provider Information

NPI Number	:	1225506272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE KELLOGG CNA

Provider Business Mailing Address
First Line	:	8489 HUNTER HILL CT
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-4811
Country	:	US
Telephone Number	:	423-774-9974
Fax Number	:	423-553-8237

Provider Business Practice Location Address
First Line	:	8489 HUNTER HILL CT
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-4811
Country	:	US
Telephone Number	:	423-774-9974
Fax Number	:	423-553-8237

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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