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Individual

KELLY THOMASON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
211 N MAIN ST, GREENEVILLE, TN 37745
(423) 787-6050
(423) 787-6054
Mailing address
PO BOX 15004, KNOXVILLE, TN 37901-5004
(865) 541-8895
(865) 633-4808

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
21773
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q053751
TN
Enumeration date
10/13/2016
Last updated
04/08/2022
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