Kelly, Derek M

Kelly, Derek M is an individual health care provider with primary practice located at 1458 W Poplar Ave Suite 100, Collierville TN 38017-0630. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery, which is considered as his primary health care specialty. Kelly, Derek M can be contacted via phone (901) 759-3100.

Contact Information

Primary practice address
1458 W Poplar Ave Suite 100 Collierville TN 38017-0630
Phone: (901) 759-3100
Fax: (901) 759-3196
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery 207XP3100X 43223 Tennessee

Profile Details

NPI number 1649499971
LBN Legal business name Kelly, Derek M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2007
Last updated Oct 7th, 2022 - about 4 years 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 1649499971 NPPES
Arkansas MEDICAID 174871001
Arkansas MEDICAID 100169565
Arkansas MEDICAID 008850343
Arkansas MEDICAID 1508536
Arkansas MEDICAID 04951036

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