Individual
KELLEY FUNDERBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
Mailing address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
22448
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00759714
—
MS
05
—
Q045204
—
TN
Enumeration date
03/29/2017
Last updated
10/05/2022
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