Provider Demographics
NPI:1073645594
Name:KELLOCK, HEIDI-MARIE ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI-MARIE
Middle Name:ALEXANDRA
Last Name:KELLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI-MARIE
Other - Middle Name:ALEXANDRA
Other - Last Name:FARINHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2200 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0005
Mailing Address - Country:US
Mailing Address - Phone:615-936-1302
Mailing Address - Fax:615-936-3467
Practice Address - Street 1:2200 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4613
Practice Address - Country:US
Practice Address - Phone:615-936-1302
Practice Address - Fax:615-936-3467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114140207PP0204X, 208000000X, 207P00000X, 2080P0204X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine