Healthcare Provider Details

I. General information

NPI: 1427463538
Provider Name (Legal Business Name): KELLEY YANDELL P.A.-C, R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WHITE BRIDGE RD STE. 300
NASHVILLE TN
37205-1499
US

IV. Provider business mailing address

28 WHITE BRIDGE RD STE. 300
NASHVILLE TN
37205-1499
US

V. Phone/Fax

Practice location:
  • Phone: 615-356-4111
  • Fax: 615-356-8011
Mailing address:
  • Phone: 615-356-4111
  • Fax: 615-356-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number0739
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2528
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: