Provider Demographics
NPI:1902521891
Name:TANKERSLEY, KELLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:TANKERSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ISBILL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1609
Mailing Address - Country:US
Mailing Address - Phone:423-718-3851
Mailing Address - Fax:
Practice Address - Street 1:2021 HAMILTON PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6046
Practice Address - Country:US
Practice Address - Phone:423-899-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant