Provider Demographics
NPI:1366872194
Name:GRESHAM, KELLEY ERANN
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ERANN
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 ASH GROVE CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6948
Mailing Address - Country:US
Mailing Address - Phone:615-480-7616
Mailing Address - Fax:
Practice Address - Street 1:332 SUMNER HALL DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3129
Practice Address - Country:US
Practice Address - Phone:615-460-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator