MEDICARE: KIDS ARE SPECIAL LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427774256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS ARE SPECIAL LLC

Provider Business Mailing Address
First Line	:	6550 CAROTHERS PKWY STE 225
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6662
Country	:	US
Telephone Number	:	931-253-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 COLLOREDO BLVD
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-2774
Country	:	US
Telephone Number	:	931-685-8111
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SYDNI CLEMMONS
Credential	:
Telephone Number	:	931-253-1110

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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Directions to “KIDS ARE SPECIAL LLC ” Practice Location

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