Provider Demographics
NPI:1881726453
Name:CHIDSEY, KELLIANN DOHERTY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLIANN
Middle Name:DOHERTY
Last Name:CHIDSEY
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 1:270 HARDING PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3727
Mailing Address - Country:US
Mailing Address - Phone:615-352-3098
Mailing Address - Fax:
Practice Address - Street 1:1900 BELMONT BLVD.
Practice Address - Street 2:BELMONT UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3757
Practice Address - Country:US
Practice Address - Phone:615-460-5506
Practice Address - Fax:615-460-6131
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG77203Medicare UPIN