Provider Demographics
NPI:1407313083
Name:KELLY, CECILIA JACQUELINE (NP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:JACQUELINE
Last Name:KELLY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:328 ANTIOCH PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2964
Mailing Address - Country:US
Mailing Address - Phone:159-887-8106
Mailing Address - Fax:
Practice Address - Street 1:328 ANTIOCH PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2964
Practice Address - Country:US
Practice Address - Phone:615-988-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN38607363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician