Provider Demographics
NPI:1366934226
Name:ANDERSON, KELLY A (APRN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:FORNARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CRAIGHEAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2254
Mailing Address - Country:US
Mailing Address - Phone:615-845-9406
Mailing Address - Fax:615-349-1696
Practice Address - Street 1:700 CRAIGHEAD ST STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2254
Practice Address - Country:US
Practice Address - Phone:615-845-9406
Practice Address - Fax:615-349-1696
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty