Provider Demographics
NPI:1174031835
Name:HEILMAN, KELLEY GALE
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:GALE
Last Name:HEILMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5107
Mailing Address - Country:US
Mailing Address - Phone:615-449-0611
Mailing Address - Fax:615-444-1574
Practice Address - Street 1:615 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5107
Practice Address - Country:US
Practice Address - Phone:615-449-0611
Practice Address - Fax:615-444-1574
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist