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Individual

KELLIE O'CONNELL SALLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ACNP-BC

Contact information

Practice address
1423 W BADDOUR PKWY, LEBANON, TN 37087-3061
(615) 257-0900
(615) 443-1444
Mailing address
PO BOX 1165, LEBANON, TN 37088-1165
(615) 257-0900
(615) 443-1444

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
17137
TN
363LC0200X
Critical Care Medicine Nurse Practitioner
17137
TN

Other

Enumeration date
11/02/2012
Last updated
10/20/2014
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