MEDICARE: MRS. KELLY HYDER FNP-C

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	363LF0000X	Family Nurse Practitioner	24819	TN

General Provider Information

NPI Number	:	1245798107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY HYDER FNP-C

Provider Business Mailing Address
First Line	:	6016 BROOKVALE LN STE 200
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-4003
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	1665 E ANDREW JOHNSON HWY STE 2
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-5826
Country	:	US
Telephone Number	:	423-639-0243
Fax Number	:	423-639-0628

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

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	02/25/2025

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