Healthcare Provider Details

I. General information

NPI: 1346531241
Provider Name (Legal Business Name): KELLY BUMPUS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HIGHWAY SUITE C 480 KNOXVILLE FOOTCARE
KNOXVILLE TN
37920
US

IV. Provider business mailing address

1932 ALCOA HWY SUITE C480
KNOXVILLE TN
37920-1527
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5700
  • Fax:
Mailing address:
  • Phone: 865-632-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number760
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: