Healthcare Provider Details

I. General information

NPI: 1366797409
Provider Name (Legal Business Name): KELLEY LEANNE WARD PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE STE L400
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

49 N DUNLAP ST FL 3
MEMPHIS TN
38103-2802
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-287-4540
Mailing address:
  • Phone: 901-287-5207
  • Fax: 901-287-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16815
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: