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
(731) 986-2938
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(901) 226-4003
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5629
TN
363AM0700X
Medical Physician Assistant
Primary
5629
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2022
Last updated
07/16/2026
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