Provider Demographics
NPI:1649758061
Name:KIRBY, KELLYE ELIZABETH (BS)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:ELIZABETH
Last Name:KIRBY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:ELIZABETH
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 S PERIMETER PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4709 PAPERMILL DR STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1921
Practice Address - Country:US
Practice Address - Phone:865-525-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator