Individual
DEREK M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1458 W POPLAR AVE, SUITE 100, COLLIERVILLE, TN 38017-0630
(901) 759-3100
(901) 759-3196
Mailing address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
(901) 759-3196
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
43223
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008850343
—
MS
05
—
04951036
—
MS
05
—
100169565
—
MS
05
—
1508536
—
TN
05
—
174871001
—
AR
Enumeration date
04/25/2007
Last updated
10/07/2022
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