person
Kellie Lawrence Henderson, PA
Medical Physician Assistant in East Ridge, Tennessee
NPI 1225145865

Kellie Lawrence Henderson is a Medical Physician Assistant based in East Ridge, TN and is specialized in Medical. Kellie Lawrence Henderson practices in East Ridge, TN and has the professional credentials of PA. The NPI Number for Kellie Lawrence Henderson is 1225145865 and holds a License No. PA0000001098 (Tennessee).

The current practice location address for Kellie Lawrence Henderson is 1508 Tombras Ave, East Ridge, TN and can be reached out via phone at 423-867-4969 and via fax at 423-867-4971.

Location: 1508 Tombras Ave, East Ridge, TN, 37412-2720
person
Provider Profile Details
NPI Number
1225145865
Provider Name
Kellie Lawrence Henderson
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
1508 Tombras Ave, East Ridge, TN, 37412-2720
Phone Number
423-867-4969
Fax Number
423-867-4971
Provider Enumeration Date
08/23/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4219886 01 TN BCBS- TENNESSEE
Q007546 05 TN
institution
Provider Business Practice Location Address Details
Address
1508 Tombras Ave
City
State
Zip
37412-2720
Phone Number
423-867-4969
Fax Number
423-867-4971
person
Provider Business Mailing Address Details
Address
1508 Tombras Ave
City
State
Zip
37412-2720
Phone Number
423-867-4969
Fax Number
423-867-4971
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA0000001098 (Tennessee)
Definition
Definition to come...
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