Provider Demographics
NPI:1407570161
Name:LOMBARDO, KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 MYATT LOOP RD
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-9034
Mailing Address - Country:US
Mailing Address - Phone:615-354-7011
Mailing Address - Fax:
Practice Address - Street 1:155 COVEY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6007
Practice Address - Country:US
Practice Address - Phone:615-472-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner