Provider Demographics
NPI:1215361969
Name:BOMBARDIERE, KELLY JO
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:BOMBARDIERE
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 1:1805 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1944
Mailing Address - Country:US
Mailing Address - Phone:850-428-1656
Mailing Address - Fax:
Practice Address - Street 1:1101 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2650
Practice Address - Country:US
Practice Address - Phone:615-460-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator