Healthcare Provider Details

I. General information

NPI: 1609746239
Provider Name (Legal Business Name): KEITH JAMES ORR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8919 BRISTOL PARK CIR APT 201
BARTLETT TN
38133-4167
US

IV. Provider business mailing address

8919 BRISTOL PARK CIR APT 201
BARTLETT TN
38133-4167
US

V. Phone/Fax

Practice location:
  • Phone: 925-428-1259
  • Fax:
Mailing address:
  • Phone: 925-428-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: