Healthcare Provider Details

I. General information

NPI: 1457865370
Provider Name (Legal Business Name): KELSEY COLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MURFREESBORO RD STE 319
FRANKLIN TN
37064-1312
US

IV. Provider business mailing address

1113 MURFREESBORO RD STE 319
FRANKLIN TN
37064-1312
US

V. Phone/Fax

Practice location:
  • Phone: 615-790-0567
  • Fax: 615-814-2924
Mailing address:
  • Phone: 931-685-1145
  • Fax: 931-685-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3443
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: