Provider Demographics
NPI:1366437238
Name:EARNEST, KELLY ELIZABETH (CPNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:EARNEST
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901
Mailing Address - Country:US
Mailing Address - Phone:865-522-9730
Mailing Address - Fax:865-637-2520
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-637-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3200P363LP0200X
TN13454363LP0200X, 363L00000X
GARN115204363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000179284OtherID BLUE CROSS INSURANCE
KY50006858OtherPASSPORT NON-PARTICIPATE
KY78004405Medicaid
KY000000179284OtherID BLUE CROSS INSURANCE
0650805Medicare ID - Type Unspecified