Provider Demographics
NPI:1093502346
Name:KELLEY, AMY (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WESTON DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-1508
Mailing Address - Country:US
Mailing Address - Phone:931-310-7000
Mailing Address - Fax:
Practice Address - Street 1:313 BLUEBIRD DR STE 2B
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2303
Practice Address - Country:US
Practice Address - Phone:731-821-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily