Healthcare Provider Details

I. General information

NPI: 1700229515
Provider Name (Legal Business Name): JAYNA KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NONCONNAH BLVD
MEMPHIS TN
38132-2108
US

IV. Provider business mailing address

1975 NONCONNAH BLVD
MEMPHIS TN
38132-2108
US

V. Phone/Fax

Practice location:
  • Phone: 901-337-1625
  • Fax:
Mailing address:
  • Phone: 901-337-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number53460
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number53460
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: