Jefferson, Kelley Vincent

Jefferson, Kelley Vincent is an sole proprietor health care provider with primary practice located at 1224 Trotwood Ave , Columbia TN 38401-4802. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Jefferson, Kelley Vincent can be contacted via phone (931) 359-4506.

Contact Information

Primary practice address
1224 Trotwood Ave Columbia TN 38401-4802
Phone: (931) 359-4506
Fax: (931) 490-7043
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD37199 Tennessee
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 37199 Tennessee
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD37199 Tennessee

Profile Details

NPI number 1154398105
LBN Legal business name Jefferson, Kelley Vincent
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 8th, 2006
Last updated Jan 9th, 2024 - about 10 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154398105 NPPES
Tennessee MEDICAID 1505466
Tennessee MEDICAID 3883064
Tennessee MEDICAID 3283015
Tennessee Other 4192108

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