Individual
SHERRY J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNIM
Contact information
Practice address
7112 DEER RIDGE RD, FAIRVIEW, TN 37062-8908
(309) 738-6481
Mailing address
7112 DEER RIDGE RD, FAIRVIEW, TN 37062-8908
(309) 738-6481
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
2671
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2671
CNIM
—
01
—
3287
R.EEG T.
—
01
—
919
R EP T.
—
Enumeration date
12/08/2020
Last updated
12/08/2020
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