Provider Demographics
NPI:1366992760
Name:WALKER, KELLY ANN (NP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6294
Mailing Address - Country:US
Mailing Address - Phone:423-569-3800
Mailing Address - Fax:423-569-1744
Practice Address - Street 1:460 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6294
Practice Address - Country:US
Practice Address - Phone:423-569-3800
Practice Address - Fax:423-569-1744
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21588363LF0000X
TN21558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily