Healthcare Provider Details

I. General information

NPI: 1174194526
Provider Name (Legal Business Name): ASHLEY MICHELLE KELLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5148A MURFREESBORO RD
LA VERGNE TN
37086-2712
US

IV. Provider business mailing address

5160 RYAN ALLEN CIR
WHITES CREEK TN
37189-5202
US

V. Phone/Fax

Practice location:
  • Phone: 615-213-2273
  • Fax:
Mailing address:
  • Phone: 516-633-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: