Basic Information
| Provider Information | |||||||||
| NPI: | 1437476843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILEY | ||||||||
| FirstName: | NOELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PMH-NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUPONT | ||||||||
| OtherFirstName: | NOELLE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PMH-NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372035180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152847263 | ||||||||
| FaxNumber: | 6152847501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371302494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153966620 | ||||||||
| FaxNumber: | 6153966625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2010 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 19180 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | APPLIED FOR | 01 | TN | MAGELLEN / BCBST | OTHER | Q014697 | 05 | TN | MEDICAID | P01536965 | 01 | TN | RR MEDICARE | OTHER |