Healthcare Provider Details

I. General information

NPI: 1699309724
Provider Name (Legal Business Name): ELIZABETH KELLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAPLE ST
MURFREESBORO TN
37130-3530
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 615-217-4770
  • Fax: 615-217-7607
Mailing address:
  • Phone: 615-284-4088
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4084
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4084
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: