Provider Demographics
NPI:1457653636
Name:JACKSON, KELSEY ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2324
Mailing Address - Country:US
Mailing Address - Phone:615-340-4000
Mailing Address - Fax:615-327-4449
Practice Address - Street 1:2001 HAYES ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2324
Practice Address - Country:US
Practice Address - Phone:615-340-4000
Practice Address - Fax:615-327-4449
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1596231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist