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NPI Code Detail

MEDICARE: MRS. KELLY RENEA ALSUP FNP-C

MEDICARE: MRS. KELLY RENEA ALSUP 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
1363LF0000XFamily Nurse Practitioner21762TN

General Provider Information

NPI Number : 1720537640
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY RENEA ALSUP FNP-C
Provider Business Mailing Address
First Line : 270 BMH PHYSICIANS OFFICE BLDG
Second Line :
City : MARYVILLE
State : TN
Zip : 37804-5904
Country : US
Telephone Number : 865-681-0103
Fax Number : 865-273-1004
Provider Business Practice Location Address
First Line : 1915 WHITE AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37916-2300
Country : US
Telephone Number : 865-331-1720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2016
Last Update Date : 04/08/2026

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