Healthcare Provider Details

I. General information

NPI: 1023544301
Provider Name (Legal Business Name): KELLIE MARSH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 LEDFORD MILL RD
TULLAHOMA TN
37388-2278
US

IV. Provider business mailing address

127 LEDFORD MILL RD
TULLAHOMA TN
37388-2278
US

V. Phone/Fax

Practice location:
  • Phone: 931-841-3311
  • Fax:
Mailing address:
  • Phone: 702-521-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number37664
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number879051
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37664
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number37664
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberRN78359
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: