Active NPI
Paul R Kelley, MD
- Psychiatry Physician
- Mountain Home, TN
National Provider Identifier
1063470706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 20774
- Practice address
- Building 52
VA Medical Center
Mountain Home, TN 37684 - Phone
- (423) 439-8000
- Fax
- (423) 439-2200
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20774 | TN | Primary |
Addresses
Primary practice location
Building 52
VA Medical Center
Mountain Home, TN 37684
Mailing address
PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 439-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20774 | TN | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288742400000",
"number": "1063470706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 699",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376840699",
"telephone_number": "423-439-8000",
"fax_number": "423-439-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BUILDING 52",
"address_2": "VA MEDICAL CENTER",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "37684",
"telephone_number": "423-439-8000",
"fax_number": "423-439-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "PAUL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2010-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "20774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.