Individual
KELLY A MUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, RNFA
Contact information
Practice address
6286 BRIARCREST AVE STE 200, MEMPHIS, TN 38120-4023
(901) 641-3000
(901) 259-1698
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 725-8347
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
192906
TN
363L00000X
Nurse Practitioner
Primary
17474
TN
363L00000X
Nurse Practitioner
901950
MS
363L00000X
Nurse Practitioner
AOO5005
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17474
TN LICENSE
TN
01
—
901950
MS LICENSE
MS
Enumeration date
03/03/2008
Last updated
04/28/2021
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