MEDICARE: NICOLE S KEARNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	41059	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	195037	OTHER	TN	BETTER HEALTH PLANS OF TN
2	4133891	OTHER	TN	BCBS
3	195037	OTHER	TN	UNISON
4	7347856	OTHER	TN	ATHENA
5	38165	OTHER	TN	TLC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568470235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE S KEARNEY M.D.

Provider Business Mailing Address
First Line	:	60 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2070
Country	:	US
Telephone Number	:	731-664-9928
Fax Number	:	731-664-9749

Provider Business Practice Location Address
First Line	:	60 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2070
Country	:	US
Telephone Number	:	731-664-9928
Fax Number	:	731-664-9749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/26/2012

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