Provider Demographics
NPI:1962120352
Name:THOMAS, KELLI JEAN (ND)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 RUNNING DEER
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2234
Mailing Address - Country:US
Mailing Address - Phone:615-804-5941
Mailing Address - Fax:
Practice Address - Street 1:813 RUNNING DEER
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2234
Practice Address - Country:US
Practice Address - Phone:615-804-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
0105868733OtherWELLNESS PRACTITIONER
71400000XOtherWELLNESS PRACTITIONER