1053847996 NPI number — DR. KELSEY JORDAN HALDEMAN AU.D.

Table of content: DR. KELSEY JORDAN HALDEMAN AU.D. (NPI 1053847996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053847996 NPI number — DR. KELSEY JORDAN HALDEMAN AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALDEMAN
Provider First Name:
KELSEY
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053847996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COVEY DR
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-5665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-591-6410
Provider Business Mailing Address Fax Number:
615-591-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COVEY DR
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-5665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-591-6410
Provider Business Practice Location Address Fax Number:
615-591-6425
Provider Enumeration Date:
05/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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