Provider Demographics
NPI:1730449141
Name:STEELY, KELLY ALEXIS (CNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALEXIS
Last Name:STEELY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5676
Mailing Address - Country:US
Mailing Address - Phone:865-271-6095
Mailing Address - Fax:
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-271-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246980363LA2200X
TN15821363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health