KELLIE LAWRENCE HENDERSON (NPI# 1225145865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225145865 |
| Entity Type | Individual |
| Full Name | KELLIE LAWRENCE HENDERSON |
| Other Name | KELLIE MICHELE LAWRENCE |
| Credential | PA |
| Practice Address |
1508 Tombras Ave East Ridge TN 37412-2720 |
| Practice Telephone | 4238674969 |
| Practice Fax Number | 4238674971 |
| Mailing Telephone | 4238674969 |
| Mailing Fax Number | 4238674971 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2015-08-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA0000001098 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BCBS- TENNESSEE | 4219886 | 01 |
| TN | Q007546 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548746399 | Kellie Henderson | Registered Nurse | 7500 Rolling Brook Dr Apt 512, Frisco, TX 75034-5446 | 2018-07-16 |
| 1720459621 | Kellie Cain Henderson | Nurse Practitioner | 1100 Northside Forsyth Dr, Suite 330, Cumming, GA 30041-6012 | 2015-10-18 |
| 1184850984 | Kellie N Henderson | Pharmacist | 1611 Nw 12th Ave, Et-b069, Miami, FL 33136-1005 | 2009-06-08 |
| Street Address |
1508 TOMBRAS AVE |
| City | EAST RIDGE |
| State | TN |
| Zip Code | 37412-2720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295701795 | Diana Novakovic Kessler | Emergency Medicine | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2006-02-24 |
| 1528560414 | Rebecca Dykes Henderson | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2018-03-06 |
| 1821590993 | Wendy Kay Dodd | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2018-03-05 |
| 1033618228 | Hannah Chong | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2018-02-02 |
| 1225498090 | Amy Dawn Latham | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2016-03-07 |
| 1114397304 | Minna Rena Deluca | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-09-30 |
| 1134599715 | Amin Sohani | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-09-25 |
| 1265818983 | Jateum Mauree Blackburn | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-08-04 |
| 1710361480 | Rhonda Lynn Renfro | Nurse Practitioner | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-07-13 |
| 1790179984 | Natalie Kathryn Mcqueen | Physician Assistant | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-03-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316482458 | East Ridge Snf Operations, LLC | Skilled Nursing Facility | 1502 Mcdonald Rd., East Ridge, TN 37412 | 2016-12-28 |
| 1487080149 | Puckett Med Van LLC | Non-emergency Medical Transport (VAN) | 5603 Ringgold Road, East Ridge, TN 37412 | 2013-09-25 |
| 1538420229 | Nathan Hartgrove | Internal Medicine | 961 Spring Creek Rd Ste 300, Chattanooga, TN 37412 | 2012-05-30 |
| 1770869042 | Jonathan Bailey Barnett I | Pharmacist | 5301 Ringold Rd, East Ridge, TN 37412 | 2011-10-31 |
| 1932482791 | Ronald P Leonard | Pharmacist | 7354 East Brainerd Rd, Chattanooga, TN 37412 | 2011-09-27 |
| 1164758561 | Zoilus, Inc | Home Health | 912 Belvoir Hills Circle, Chattanooga, TN 37412 | 2009-10-20 |
| 1093935157 | Alan L Crisman | Dentist | 1421 Armour Street, Chattanooga, TN 37412 | 2007-04-30 |
| 1700949989 | Keith Brian Sparkman | Optometrist | 1013 Spring Creek Rd, Chattanooga, TN 37412 | 2006-12-18 |
| 1174617161 | Shahul H Majeed | Obstetrics & Gynecology | 1012 Spring Creek Road, Chattanooga, TN 37412 | 2006-10-03 |
| 1356434070 | Mckinley Snipes Lundy Sr. | Preventive Medicine | 931 Spring Creek Road, Suite 200, Chattanooga, TN 37412 | 2006-10-02 |
| Find all providers in zip 37412 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790179984 | Natalie Kathryn Mcqueen | Physician Assistant | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2015-03-25 |
| 1003072059 | Patricia Diane Blasick | Physician Assistant | 1508 Tombras Ave, East Ridge, TN 37412-2720 | 2008-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346840972 | Alexis Sierra Foster | Physician Assistant | 953 Prince Ave, Erwin, TN 37650-1445 | 2020-11-01 |
| 1972110831 | Marleen Yosef | Physician Assistant | 6 Whitsett Rd, Nashville, TN 37210-5345 | 2020-09-24 |
| 1538772744 | Kaitlyn Blair Barger | Physician Assistant | 2100 Clinch Ave Ste 120, Knoxville, TN 37916-2288 | 2020-08-26 |
| 1225653967 | Molly Ann Waggoner | Physician Assistant | 9050 Executive Park Dr Ste 100b, Knoxville, TN 37923-4616 | 2020-06-09 |
| 1134749922 | Mckenzie Jacobson | Physician Assistant | 302 Tyson Ave # B, Paris, TN 38242-4576 | 2020-04-21 |
| 1316580913 | Donald Jacob Calella | Physician Assistant | 8146 Propeller Dr, Ooltewah, TN 37363-9561 | 2019-10-26 |
| 1811458565 | Physician Associate Resources, Plc | Physician Assistant | 1559 Highland Park Drive, Lenoir City, TN 37772 | 2019-03-26 |
| 1336617059 | Micaela L Goebel | Physician Assistant | 120 Tanner Pl Bldg H, Clinton, TN 37716-6684 | 2018-11-12 |
| 1700369162 | Lauren Peyton Hunley | Physician Assistant | 6890 W Andrew Johnson Hwy, Talbott, TN 37877-8610 | 2018-09-12 |
| 1275039471 | Jessica Taylor Epting | Physician Assistant | 107 Glen Oak Blvd Ste 200, Hendersonville, TN 37075-3162 | 2018-04-05 |
| Find all providers with the same taxonomy | ||||
| City | EAST RIDGE |
| Zip Code | 37412 |
Please comment or provide details below to improve the information on KELLIE LAWRENCE HENDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.