Provider Demographics
NPI:1891706644
Name:KELLEY, PATRICIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVENUE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5215
Mailing Address - Country:US
Mailing Address - Phone:901-761-2370
Mailing Address - Fax:901-761-2896
Practice Address - Street 1:6005 PARK AVENUE
Practice Address - Street 2:SUITE 512
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5215
Practice Address - Country:US
Practice Address - Phone:901-761-2370
Practice Address - Fax:901-761-2896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4042320OtherBCBST
TN3683352Medicaid
TN4131554OtherAETNA
TN4131554OtherAETNA