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NPI Code Detail

MEDICARE: MRS. REBECCA WILSON KELLEY CRNP

MEDICARE: MRS. REBECCA WILSON KELLEY CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1-114513AL

General Provider Information

NPI Number : 1417499096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA WILSON KELLEY CRNP
Provider Business Mailing Address
First Line : 201 MONROE ST
Second Line : SUITE 1350
City : MONTGOMERY
State : AL
Zip : 36104-3735
Country : US
Telephone Number : 334-206-5675
Fax Number :
Provider Business Practice Location Address
First Line : 2350 HARGROVE RD E
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35405-2612
Country : US
Telephone Number : 205-562-6900
Fax Number : 205-759-4039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2016
Last Update Date : 11/14/2016

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