Healthcare Provider Details

I. General information

NPI: 1467961896
Provider Name (Legal Business Name): OUR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 HAYES ST
NASHVILLE TN
37203-2504
US

IV. Provider business mailing address

1804 HAYES ST
NASHVILLE TN
37203-2504
US

V. Phone/Fax

Practice location:
  • Phone: 615-341-4911
  • Fax:
Mailing address:
  • Phone: 615-341-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LEANNA DUGAN
Title or Position: CPNP
Credential:
Phone: 615-341-4911