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General NPI Number Information
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NPI Number | 1407425747
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Entity Type | Organization
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Legal Business Name | BRENTWOOD PEDIATRIC CARE PLLC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 343 FRANKLIN ROAD SUITE 106
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City | BRENTWOOD
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State | TN
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Zip | 37027-5250
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Country | US
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Telephone | 615-814-4500
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Fax | 615-814-4501
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Provider Business Mailing Address
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Address Line | 6001 BELLE RIVE DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-5703
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Country | US
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Telephone | 630-779-6167
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. JILL SAUSER KELLY
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Credential | MD
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Telephone | 630-779-6167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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