Healthcare Provider Details

I. General information

NPI: 1497965115
Provider Name (Legal Business Name): KELLY LYNN MOORE M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 5TH AVE N 1ST FLOOR, CORDELL HULL BUILDING
NASHVILLE TN
37243-0001
US

IV. Provider business mailing address

4487 POST PL UNIT 34
NASHVILLE TN
37205-1600
US

V. Phone/Fax

Practice location:
  • Phone: 615-741-7247
  • Fax: 615-532-8526
Mailing address:
  • Phone: 615-352-1873
  • Fax: 615-532-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number36157
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: