Provider Demographics
NPI:1639343742
Name:KELCH, KIMBERLY K (ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:KELCH
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10050 W BELL RD STE 35
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1290
Practice Address - Country:US
Practice Address - Phone:623-281-1130
Practice Address - Fax:480-906-2179
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13358363L00000X
FLARNP9319197363LA2100X
AZAP4061363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1031502218Medicare PIN
3341826Medicare PIN