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NPI Code Detail

MEDICARE: PROF. KELLY CLIFFORD

MEDICARE: PROF. KELLY CLIFFORD
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
1163W00000XRegistered Nurse143620TN

General Provider Information

NPI Number : 1851422968
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. KELLY CLIFFORD
Provider Business Mailing Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 140 DOVER ST
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-2776
Country : US
Telephone Number : 931-684-0000
Fax Number : 931-684-5860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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