Provider Demographics
NPI:1457865370
Name:COLLEY, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:COLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MURFREESBORO RD
Mailing Address - Street 2:STE 319
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1312
Mailing Address - Country:US
Mailing Address - Phone:931-685-1145
Mailing Address - Fax:931-685-8014
Practice Address - Street 1:1113 MURFREESBORO RD STE 319
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1312
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:615-814-2924
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3443363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical