Healthcare Provider Details

I. General information

NPI: 1346021334
Provider Name (Legal Business Name): KELLEY LEBERTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY PIPKIN

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 900A
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 615-292-1253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1967
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: