Kelly M McCallum, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

13555 Issued in TN

Practice address

2490 Parr Ave
Suite 3
Dyersburg, TN 38024-2029

Phone

(731) 286-8007

Fax

(731) 286-8019

NPI assigned

Jul 24, 2008

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly M Griffin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Convienent Care Clinic

  • Clinic/Center
  • Dyersburg, TN
  • NPI 1760759617
  NPD Authorized official
• Independent Radiology Associates PLC

  • Diagnostic Radiology Physician
  • Dyersburg, TN
  • NPI 1194804906
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1396900700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 PARR AVE",
            "address_2": "SUITE 3",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242029",
            "telephone_number": "731-286-8007",
            "fax_number": "731-286-8019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 PARR AVE",
            "address_2": "SUITE 3",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242029",
            "telephone_number": "731-286-8007",
            "fax_number": "731-286-8019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "13555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GRIFFIN",
            "middle_name": "M",
            "credential": "ANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maple Ridge Manor, Inc (Maple Ridge Assisted Living)
• Julie Markham, R.N.
• Kristen Nicole Massey, MSN, APRN, FNP-C
• Katie May
• Catherine Kellee McBride, PT
• Chaslelisa Alexandrea McClain, CASE MANAGER
• Pascaline McClinton, MD
• McCoy Medical
• Paulette McCulloch
• William Ashton McGuire, PA-C

• Nurse Practitioner in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.