Individual
SOPHIA GRACE KILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1622 WESTGATE CIR, BRENTWOOD, TN 37027-8019
(629) 255-2277
(629) 255-4258
Mailing address
222 22ND AVE N, NASHVILLE, TN 37203-1852
(629) 255-3486
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4286
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4286
PA LICENSE
TN
05
—
Q076744
—
TN
Enumeration date
11/03/2020
Last updated
02/01/2023
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