Provider Demographics
NPI:1467580597
Name:WELCH, KIMBERLY SHONTRELL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHONTRELL
Last Name:WELCH
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 1:1640 COMANCHE RUN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5633
Mailing Address - Country:US
Mailing Address - Phone:615-279-6774
Mailing Address - Fax:
Practice Address - Street 1:1921 RANSOM PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3841
Practice Address - Country:US
Practice Address - Phone:615-279-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker