Provider Demographics
NPI:1841579398
Name:CONYERS, KELSEA RAE
Entity Type:Individual
Prefix:MRS
First Name:KELSEA
Middle Name:RAE
Last Name:CONYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELSEA
Other - Middle Name:RAE
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 HWY 46 S
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2565
Mailing Address - Country:US
Mailing Address - Phone:615-446-3797
Mailing Address - Fax:
Practice Address - Street 1:721 HWY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2565
Practice Address - Country:US
Practice Address - Phone:615-446-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT63-02-9298171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator