Provider Demographics
NPI:1679539092
Name:PHILLIPS, KELLY LEIGH (APRN-BC, FNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEIGH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 HERON CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9283
Mailing Address - Country:US
Mailing Address - Phone:423-344-4126
Mailing Address - Fax:
Practice Address - Street 1:2501 CITICO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1127
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-3510
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily