Individual
ANDREA KELLEY GORE HAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
108 W BLACKWELL ST, TULLAHOMA, TN 37388-3505
(931) 841-3821
(931) 841-3869
Mailing address
1505 BONNER WAY, ESTILL SPRINGS, TN 37330-4255
(931) 607-0587
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN8403
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031057933
MEDICARE
TN
05
—
1510617
—
TN
Enumeration date
10/25/2006
Last updated
02/29/2024
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