Provider Demographics
NPI:1033118633
Name:WREN, KELVIN (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:WREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MURRAY GUARD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3742
Mailing Address - Country:US
Mailing Address - Phone:731-660-4916
Mailing Address - Fax:731-660-6759
Practice Address - Street 1:174 MURRAY GUARD DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:731-660-4916
Practice Address - Fax:731-660-6759
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN395982083P0500X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Not Answered202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner