Kelsey Gardner Laporte, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

11255 Issued in TN

Practice address

205 Southdowne Dr
Maryville, TN 37801-3747

Phone

(865) 381-8867

Fax

(865) 724-1803

NPI assigned

Jun 26, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Kelsey Gardner Former name

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Tennessee Valley Oral Surgery. PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1861013195
  NPD
• Bellevue Oral and Maxillofacial Surgery LLC

  dba Premier Oral and Maxillofacil Surg

  • Dental Clinic/Center
  • Papillion, NE
  • NPI 1558690545
  NPD (past)
• Kennedy Dental Associates, P.C.

  • General Practice Dentistry
  • Bellevue, NE
  • NPI 1679648521

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1457791253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SOUTHDOWNE DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378013747",
            "telephone_number": "865-381-8867",
            "fax_number": "865-724-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SOUTHDOWNE DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378013747",
            "telephone_number": "865-381-8867",
            "fax_number": "865-724-1803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 John F Kennedy Dr",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "NE",
            "postal_code": "68005",
            "country_code": "US",
            "telephone_number": "402-291-3535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Oral and Maxillofacial Surgery",
            "address_2": "984125 Nebraska Medical Center",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681980001",
            "country_code": "US",
            "telephone_number": "402-559-6445",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "546 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Papillion",
            "state": "NE",
            "postal_code": "680462632",
            "country_code": "US",
            "telephone_number": "402-916-5800",
            "fax_number": "402-916-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER LAPORTE",
        "first_name": "KELSEY",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NE",
            "license": "7105",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TN",
            "license": "11255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "GARDNER",
            "prefix": "DR.",
            "credential": "DDS, MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Denise Galloway, PT
• Ellen Galvez, A-LPC/MHSP
• Claudia C Gammon, FNP-BC
• Jessica Massey Garcia, NP-C
• Lea Roque Garcia, M.T.
• Michael Scott Gardner, DO
• Tiffani Garner
• Julie Rochelle Garren, PHARMD.
• Joy Garrett, RN
• Nancy F Garza, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Maryville, TN
• Providers in Maryville, TN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.