Individual
KELLY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3493 VETERANS DR N STE C, HUNTINGDON, TN 38344-6230
(731) 986-2933
Mailing address
211 MAPLE ST, HUNTINGDON, TN 38344-3124
(731) 415-4052
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5629
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/08/2022
Last updated
07/29/2024
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