1497965115 NPI number — DR. KELLY LYNN MOORE M.D., MPH

Table of content: DR. KELLY LYNN MOORE M.D., MPH (NPI 1497965115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497965115 NPI number — DR. KELLY LYNN MOORE M.D., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
KELLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., MPH
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:
1497965115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4487 POST PL
Provider Second Line Business Mailing Address:
UNIT 34
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-352-1873
Provider Business Mailing Address Fax Number:
615-532-8526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 5TH AVE N
Provider Second Line Business Practice Location Address:
1ST FLOOR, CORDELL HULL BUILDING
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37243-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-741-7247
Provider Business Practice Location Address Fax Number:
615-532-8526
Provider Enumeration Date:
05/23/2007

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: 2083P0901X , with the licence number:  36157 , 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)





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