Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19305 | TN |
NPI | 1033514773 |
---|---|
Provider Name | Mr. James Kelly Speck |
First Address | Nashville, TN 37212-4029 |
Second Address | Nashville, TN 37212-4029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 23/10/2014 |