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General NPI Number Information
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NPI Number | 1346531241
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Entity Type | Individual
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Provider Name | KELLY BUMPUS D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 1932 ALCOA HIGHWAY SUITE C 480 KNOXVILLE FOOTCARE
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City | KNOXVILLE
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State | TN
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Zip | 37920
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Country | US
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Telephone | 865-632-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1932 ALCOA HWY SUITE C480
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City | KNOXVILLE
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State | TN
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Zip | 37920-1527
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Country | US
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Telephone | 865-632-5700
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 760
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License Number State | TN
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