Provider Demographics
NPI:1144469594
Name:MESSEMER, KELLY ANNE (LPN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MESSEMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4755
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0755
Mailing Address - Country:US
Mailing Address - Phone:423-756-2740
Mailing Address - Fax:423-756-4854
Practice Address - Street 1:131 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3018
Practice Address - Country:US
Practice Address - Phone:423-756-2740
Practice Address - Fax:423-756-4854
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse