Provider Demographics
NPI:1427463538
Name:YANDELL, KELLEY (PA-C, RD)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:YANDELL
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-356-4111
Mailing Address - Fax:615-356-8011
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:STE. 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-356-4111
Practice Address - Fax:615-356-8011
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0739133VN1005X
TN2528363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010216Medicaid
TN103I975951Medicare PIN