MEDICARE: RED FERN THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1114817541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED FERN THERAPY PLLC

Provider Business Mailing Address
First Line	:	3144 OLD FRANKLIN RD APT 11101
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-4819
Country	:	US
Telephone Number	:	615-785-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3328
Country	:	US
Telephone Number	:	615-200-6155
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAYLIE HACKETT
Credential	:
Telephone Number	:	615-785-7591

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	03/10/2026

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