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General NPI Number Information
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NPI Number | 1265050132
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Entity Type | Individual
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Provider Name | LEONA JOYCE KELLER
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 2601 JESS NEELY DR
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City | NASHVILLE
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State | TN
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Zip | 37212-2039
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Country | US
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Telephone | 847-204-2448
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 JESS NEELEY DR VANDERBILT SPORTS MEDICINE
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City | NASHVILLE
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State | TN
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Zip | 37212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2956
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License Number State | TN
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