Provider Demographics
NPI:1558343087
Name:KELLEY, ALAN DEWITT KENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DEWITT KENNETT
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:WHITWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37397-5373
Mailing Address - Country:US
Mailing Address - Phone:423-658-9200
Mailing Address - Fax:
Practice Address - Street 1:13851 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397-5373
Practice Address - Country:US
Practice Address - Phone:423-658-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080076957OtherMEDICARE RAILROAD
WAKE9116OtherBLUE SHIELD
WA104490OtherLABOR & INDUSTRIES
WA1016815Medicaid
WA1016815Medicaid
WAG217120503Medicare PIN