Provider Demographics
NPI:1649809138
Name:BEVEL, KALEY A (MD)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:A
Last Name:BEVEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BIG STATION CAMP BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8466
Mailing Address - Country:US
Mailing Address - Phone:613-328-3400
Mailing Address - Fax:
Practice Address - Street 1:225 BIG STATION CAMP BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8466
Practice Address - Country:US
Practice Address - Phone:615-396-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN65957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program