Individual
KELLIE DEFFENDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232-2598
(615) 936-2000
Mailing address
719 THOMPSON LN STE 30330, NASHVILLE, TN 37204-4701
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11020
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100047081
PHP TENNCARE
TN
05
—
3634033
—
TN
01
—
4101930
BLUECARE
TN
01
—
P00243205
MEDICARE TRAVELERS
TN
Enumeration date
05/31/2006
Last updated
10/23/2020
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