BOBBY J. KELLEY (NPI# 1417966755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417966755 |
| Entity Type | Individual |
| Full Name | BOBBY J. KELLEY |
| Credential | M.D. |
| Practice Address |
6029 Walnut Grove Rd Suite 105 Memphis TN 38120-2112 |
| Practice Telephone | 9017473501 |
| Practice Fax Number | 9017473516 |
| Mailing Telephone | 9017473501 |
| Mailing Fax Number | 9017473516 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2013-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MD4916 | TN | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 118691001 | 05 | |
| TN | 3159521 | 05 | |
| TN | BLUE CROSS BLUE SHIELD | 4008478 | 01 |
| TN | RAILROAD MEDICARE | 390007662 | 01 |
| MS | 00125652 | 05 |
| Street Address |
6029 WALNUT GROVE RD SUITE 105 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38120-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003819269 | Aleksandar Jankov | Internal Medicine | 6029 Walnut Grove Rd, Suite 301, Memphis, TN 38120-2112 | 2005-05-23 |
| 1932731957 | Summer Rhae Hess | Nurse Practitioner | 6029 Walnut Grove Rd, Memphis, TN 38120-2112 | 2020-02-07 |
| 1396207882 | Ashley Marie Hatchett | Nurse Practitioner | 6029 Walnut Grove Rd, Memphis, TN 38120-2112 | 2019-04-03 |
| 1477966687 | Saint Francis Medical Partners, General Surgery, L.L.C. | Colon & Rectal Surgery | 6029 Walnut Grove Rd, Ste. 404, Memphis, TN 38120-2112 | 2014-06-05 |
| 1164745238 | Mid South Regional Thoracic Center, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6029 Walnut Grove Rd, Suite 100, Memphis, TN 38120-2112 | 2010-03-03 |
| 1104056555 | Rachel E. Harrison | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6029 Walnut Grove Rd, Memphis, TN 38120-2112 | 2009-07-20 |
| 1063673184 | Cardiac Surgery Associates, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6029 Walnut Grove Rd, Suite 109, Memphis, TN 38120-2112 | 2008-06-20 |
| 1578723276 | Drew S. Dill | Internal Medicine | 6029 Walnut Grove Rd, Memphis, TN 38120-2112 | 2008-06-16 |
| 1336313170 | Anton Surath Nisetus Dias Perera | Surgery | 6029 Walnut Grove Rd, Suite # 401, Memphis, TN 38120-2112 | 2008-04-14 |
| 1730361429 | Memphis Eye Clinic Plc | Ophthalmology | 6029 Walnut Grove Rd, Suite 101, Memphis, TN 38120-2112 | 2007-12-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093285637 | Cobblestone Midwifery | Midwife | 5617 Ashley Square South, Memphis, TN 38120 | 2018-11-27 |
| 1649768870 | River City Neuropsychology, Pllc | Psychologist | 1661 International Dr., Suite 400, Memphis, TN 38120 | 2018-04-24 |
| 1841676152 | Jody Lavaun Clements | Dentist | 795 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2015-08-10 |
| 1578957122 | Christina Lumpkin | Nurse Practitioner | 6305 Humphreys Blvd Ste 101, Memphis, TN 38120 | 2015-03-21 |
| 1316352099 | Daniel Poor | Emergency Medicine | Baptist Memorial Hospital Memphis, 124 N. Humphrey's Blvd, Memphis, TN 38120 | 2014-06-21 |
| 1245643246 | Kysha Saleem | Nurse Practitioner | 6027 Walnut Grove Rd., Suite 312, Memphis, TN 38120 | 2014-06-06 |
| 1376962613 | John Christopher Swearingen | Dentist | 780 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2014-04-15 |
| 1275884645 | Rebecca Leigh Goedecke | Nurse Practitioner | 6215 Humphreys Blvd Ste 301, Memphis, TN 38120 | 2012-09-26 |
| 1730475179 | Sarah Elizabeth Hammond | Surgery | Plastic Surgery Group, 80 Humphreys Blvd #100, Memphis, TN 38120 | 2011-06-23 |
| 1922302785 | Daniel L Hester | Nurse Anesthetist, Certified Registered | 1755 Kirby Parkway Suite 330, Memphis, TN 38120 | 2011-01-07 |
| Find all providers in zip 38120 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487270963 | Daphne Hall | Specialist | 2504 Mount Moriah Rd Bldg D, Memphis, TN 38115-1519 | 2020-06-22 |
| 1013481597 | Tiffany Powell | Specialist | 679 S Mendenhall Rd, Memphis, TN 38117-5212 | 2019-01-17 |
| 1245735067 | Xclusive Kutz Barbershop | Specialist | 3610 Park Ave, Memphis, TN 38111-5630 | 2018-03-25 |
| 1033582267 | Aletta Roebuck | Specialist | 2275 Edgewood Cv, Memphis, TN 38104-4357 | 2015-11-10 |
| 1922482967 | Convalescent Home Health Services | Specialist | 2904 Chelsea Ave, Memphis, TN 38108-1705 | 2015-07-18 |
| 1821407859 | Rachel Siegel | Specialist | 430 Essex Pl, Memphis, TN 38120-2422 | 2014-08-04 |
| 1790199180 | Supplemental Specialists | Specialist | 7665 Easterly Ln, Memphis, TN 38125-4313 | 2014-06-13 |
| 1982027769 | Dowen E Synder | Specialist | 6224 Shady Grove Ln, Memphis, TN 38120-3107 | 2014-01-29 |
| 1962845503 | Atlas Health, Pllc | Specialist | 14 N Mclean Blvd, Memphis, TN 38104-2645 | 2013-04-13 |
| 1760725659 | Jyothishree PC | Specialist | 6005 Park Ave Ste 626b, Memphis, TN 38119-5221 | 2013-03-29 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.