Individual
KELLEY VINCENT JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1224 TROTWOOD AVE, COLUMBIA, TN 38401-4802
(931) 359-4506
(931) 490-7043
Mailing address
2717 EAST OAKLAND AVENUE, JOHNSON CITY, TN 37601-1843
(423) 926-2358
(423) 926-2680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37199
TN
207R00000X
Internal Medicine Physician
MD37199
TN
208000000X
Pediatrics Physician
MD37199
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1505466
—
TN
05
—
3283015
—
TN
05
—
3883064
—
TN
01
—
4192108
BCBST
TN
Enumeration date
03/08/2006
Last updated
01/09/2024
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