Henderson, Kellie Lawrence
Henderson, Kellie Lawrence is an individual health care provider with primary practice located at 1508 Tombras Ave , East Ridge TN 37412-2720. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Henderson, Kellie Lawrence can be contacted via phone (423) 867-4969.Contact Information
Primary practice address
1508 Tombras Ave
East Ridge TN 37412-2720
Phone: (423) 867-4969
Fax: (423) 867-4971
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA0000001098 | Tennessee |
Profile Details
| NPI number | 1225145865 |
|---|---|
| LBN Legal business name | Henderson, Kellie Lawrence |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 23rd, 2006 |
| Last updated | Aug 5th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225145865 | NPPES |
| Tennessee | Other | 4219886 | BCBS- TENNESSEE |
| Tennessee | MEDICAID | Q007546 | BCBS- TENNESSEE |
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