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General NPI Number Information
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NPI Number | 1730566977
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE PEDIATRIC SERVICES, PLLC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 2355 DOUBLE LOG CABIN RD
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City | LEBANON
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State | TN
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Zip | 37087-7481
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Country | US
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Telephone | 615-568-3865
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 DOUBLE LOG CABIN RD
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City | LEBANON
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State | TN
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Zip | 37087-7481
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Country | US
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Telephone | 615-568-3865
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/CEO
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Name | KRISTA SHAYE BRIGHT
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Credential | M.S., CCC/SLP
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Telephone | 615-568-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0000003330
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License Number State | TN
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