Provider Demographics
NPI:1699519660
Name:KELLEY, SANDRA KAYE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAYE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 ALCOA HWY STE F-380
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-305-9171
Mailing Address - Fax:
Practice Address - Street 1:1926 ALCOA HWY STE F-380
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-305-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily