Provider Demographics
NPI:1841243292
Name:CHUMBLEY, KELLY D (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:CHUMBLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4342
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-5109
Practice Address - Fax:423-224-5120
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1771207P00000X
VA0102202993207P00000X
OH34008110207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3319838Medicaid
TN3319837Medicaid
TN103I939470Medicare PIN
TN3319837Medicaid
TN3319838Medicaid
TN3319837Medicare PIN