Provider Demographics
NPI:1679047146
Name:LUMLEY, KELLEY (NP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:LUMLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3945
Mailing Address - Country:US
Mailing Address - Phone:901-747-3630
Mailing Address - Fax:
Practice Address - Street 1:27 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3949
Practice Address - Country:US
Practice Address - Phone:731-424-1001
Practice Address - Fax:731-426-0344
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN205390163W00000X
TN25362363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily