DEREK M KELLY (NPI# 1649499971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649499971 |
| Entity Type | Individual |
| Full Name | DEREK M KELLY |
| Credential | MD |
| Practice Address |
1458 W Poplar Ave Suite 100 Collierville TN 38017-0630 |
| Mailing Address |
1400 S Germantown Rd Germantown TN 38138-2205 |
| Practice Telephone | 9017593100 |
| Practice Fax Number | 9017593196 |
| Mailing Telephone | 9017593100 |
| Mailing Fax Number | 9017593196 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2018-05-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
43223 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 174871001 | 05 | |
| MS | 04951036 | 05 | |
| TN | 1508536 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1211 Union Ave Ste 500, Memphis, TN 381046656 | 9017593100 | |
| 7545 Airways Blvd, Southaven, MS 386715806 | 9017593100 | |
| 1400 S Germantown Rd, Germantown, TN 381382205 | 9017593100 | |
| 8000 Centerview Pkwy Ste 500, Cordova, TN 380184254 | 9017593100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043649239 | Derek Kelly | Physical Therapist | 3800 Shamrock Dr, Charlotte, NC 28215-3220 | 2013-11-07 |
| 1164622007 | Derek Keith Kelly | Emergency Medicine | 1400 8th Ave, Fort Worth, TX 76104-4110 | 2007-07-19 |
| 1407989106 | Derek Joseph Kelly | Family Medicine | 2740 W Foster Ave, Suite 209, Chicago, IL 60625-3500 | 2007-03-13 |
| 1306808597 | Derek Kelly | Dentist | 1597 Washington Pike Ste A5, Bridgeville, PA 15017-2881 | 2006-04-04 |
| Street Address |
1458 W POPLAR AVE SUITE 100 |
| City | COLLIERVILLE |
| State | TN |
| Zip Code | 38017-0630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659378396 | Jara Best Jones | Pediatrics | 1458 W Poplar Ave, Suite 201, Collierville, TN 38017-0630 | 2005-07-07 |
| 1992106736 | Michael Wesley Duckworth | Physical Therapist | 1458 W Poplar Ave, Collierville, TN 38017-0630 | 2014-09-11 |
| 1194167510 | Natalie Wyatt | Audiologist | 1458 W Poplar Ave, Suite 204, Collierville, TN 38017-0630 | 2013-07-26 |
| 1558591487 | Mary Ann H Bryan | Physical Therapist | 1458 W Poplar Ave, Suite 100, Collierville, TN 38017-0630 | 2009-07-27 |
| 1952406860 | Elizabeth Shea Cross | Physical Therapist | 1458 W Poplar Ave, Suite 200, Collierville, TN 38017-0630 | 2006-09-14 |
| 1073533204 | Karen Lemar Siegfried | Specialist/Technologist | 1458 W Poplar Ave, Suite 100, Collierville, TN 38017-0630 | 2006-07-20 |
| 1114997814 | Michael S. Tankersley | Allergy & Immunology | 1458 W Poplar Ave, Ste 205, Collierville, TN 38017-0631 | 2006-01-25 |
| 1952309312 | John Ellis IIi | Pediatrics | 1458 W Poplar Ave, Suite 201, Collierville, TN 38017-0630 | 2005-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827338 | George Nathan Freeman IIi | Chiropractor | 2028 W. Poplar, Suite 105, Collierville, TN 38017 | 2020-10-01 |
| 1104440171 | Cecelia Hunt | Social Worker | 2555 Halle Parkwsy, Collierville, TN 38017 | 2020-06-04 |
| 1053803403 | Sarah Harris | Physical Therapist | 605 Heather Lake Cv, Collierville, TN 38017 | 2018-06-01 |
| 1023507811 | Sandra P Morris | Pharmacist | 560 West Poplar, Collierville, TN 38017 | 2018-05-07 |
| 1043751159 | Rahim Panjwani | Physical Therapist | 2028 W. Poplar Ave, Collierville, TN 38017 | 2017-03-09 |
| 1104273234 | The Branch House | Counselor | 562 Center St, Collierville, TN 38017 | 2016-05-18 |
| 1760840052 | Amodeo Chiropractic Center Inc | Chiropractor | 161 Hwy 72 East, Collierville, TN 38017 | 2016-02-02 |
| 1235520628 | Bonnie Morales | Nurse Practitioner | 472 W. Poplar Ave, Collierville, TN 38017 | 2015-02-06 |
| 1841616513 | First Choice Transportation | Non-emergency Medical Transport (VAN) | 336 E. Valleywood Drive, Collierville, TN 38017 | 2014-03-05 |
| 1821424276 | Shana Cole Cannon | Licensed Practical Nurse | 777 W. Poplar Ave., Suite 104, Collierville, TN 38017 | 2013-09-17 |
| Find all providers in zip 38017 | ||||
| Taxonomy Code | 207XP3100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Pediatric Orthopaedic Surgery |
| An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932617271 | Blue Ridge Medical Management Corpoartion | Orthopaedic Surgery | 410 N State of Franklin Rd Ste 130, Johnson City, TN 37604-6972 | 2018-01-22 |
| 1285899898 | The Austin Center | Orthopaedic Surgery | 2277 West St, Suite 100, Germantown, TN 38138-5961 | 2008-07-23 |
| 1356880199 | Shriners Hospitals for Children | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2017-02-13 |
| 1366769994 | Robert Quigley | Orthopaedic Surgery | 910 Blackford St, Chattanooga, TN 37403-1405 | 2010-04-21 |
| 1275867715 | Brandon Green | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2009-10-01 |
| 1285836056 | Jeffrey Edward Martus | Orthopaedic Surgery | 3601 Tvc, Nashville, TN 37232-5100 | 2007-06-04 |
| 1972650869 | Jonathan Gregory Schoenecker | Orthopaedic Surgery | 3601 Tvc, Nashville, TN 37232-5100 | 2007-01-04 |
| 1760462261 | Wendell Moses | Orthopaedic Surgery | 900 E 3rd St, Chattanooga, TN 37403-2101 | 2006-01-19 |
| City | COLLIERVILLE |
| Zip Code | 38017 |
Please comment or provide details below to improve the information on DEREK M KELLY.
| 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.