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NPI Code Detail

MEDICARE: KELLY M SPEARMAN

MEDICARE: KELLY M SPEARMAN
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
1101YM0800XMental Health CounselorIL

General Provider Information

NPI Number : 1922611953
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M SPEARMAN
Provider Business Mailing Address
First Line : 1321 MURFREESBORO PIKE STE 702
Second Line :
City : NASHVILLE
State : TN
Zip : 37217-2679
Country : US
Telephone Number : 844-359-7629
Fax Number : 615-577-5654
Provider Business Practice Location Address
First Line : 3551 PARK PLAZA RD
Second Line :
City : PADUCAH
State : KY
Zip : 42001-5948
Country : US
Telephone Number : 270-702-4641
Fax Number : 615-577-5654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 05/19/2026

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