1275874208 NPI number — MISS KELLY ANNE DAVIS NP

Table of content: MISS KELLY ANNE DAVIS NP (NPI 1275874208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275874208 NPI number — MISS KELLY ANNE DAVIS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
KELLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1275874208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3841 GREEN HILLS VILLAGE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-924-8197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
PCCU
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-0881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2013

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: 363LP0222X , with the licence number:  104393 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0222X , with the licence number: 17456 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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