Provider Demographics
NPI:1194098145
Name:BARNES, KELLY SMITH (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SMITH
Last Name:BARNES
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8633 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-2309
Mailing Address - Country:US
Mailing Address - Phone:731-364-5613
Mailing Address - Fax:731-599-9663
Practice Address - Street 1:8633 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2309
Practice Address - Country:US
Practice Address - Phone:731-364-5613
Practice Address - Fax:731-599-9663
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007336363LF0000X
TNAPN16412363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily