Healthcare Provider Details

I. General information

NPI: 1649624677
Provider Name (Legal Business Name): KEITH MICHAEL NORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STONEBRIDGE BLVD
JACKSON TN
38305-2040
US

IV. Provider business mailing address

111 STONEBRIDGE BLVD
JACKSON TN
38305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-7888
  • Fax: 731-423-1827
Mailing address:
  • Phone: 731-427-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number64610
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number64610
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number64610
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: