Basic Information
| Provider Information | |||||||||
| NPI: | 1750854899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 280 | ||||||||
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| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385030280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233101642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385014294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315285587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 25305 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.