Provider Demographics
NPI:1104107754
Name:KORBE, KELLIE (FNP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:KORBE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:HEITMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 50998
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-0998
Mailing Address - Country:US
Mailing Address - Phone:865-330-6320
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:210 WESTWOOD PL STE 110
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7554
Practice Address - Country:US
Practice Address - Phone:615-206-2462
Practice Address - Fax:833-983-2043
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170921163W00000X
TN16097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse