Healthcare Provider Details

I. General information

NPI: 1447939442
Provider Name (Legal Business Name): KELSEY COTTINGHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NEW SHACKLE ISLAND RD STE 341C
HENDERSONVILLE TN
37075-2354
US

IV. Provider business mailing address

115 MIDDLETON ST APT 109
NASHVILLE TN
37210-2246
US

V. Phone/Fax

Practice location:
  • Phone: 615-826-1716
  • Fax:
Mailing address:
  • Phone: 757-784-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5647
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: