Provider Demographics
NPI:1912395351
Name:KELLEY, ANN (PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
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 1:301 S PERIMETER PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4143
Mailing Address - Country:US
Mailing Address - Phone:615-726-3603
Mailing Address - Fax:
Practice Address - Street 1:301 S PERIMETER PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4143
Practice Address - Country:US
Practice Address - Phone:615-726-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical