Provider Demographics
NPI:1437382587
Name:MCINTYRE, KELLY (ANP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GILL AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-7209
Mailing Address - Country:US
Mailing Address - Phone:865-546-7330
Mailing Address - Fax:865-546-7381
Practice Address - Street 1:315 GILL AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-7209
Practice Address - Country:US
Practice Address - Phone:865-546-7330
Practice Address - Fax:865-546-7381
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14275363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health