Healthcare Provider Details

I. General information

NPI: 1265831002
Provider Name (Legal Business Name): KELLEY KOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLLEGE ST STE E
ATHENS AL
35611-2714
US

IV. Provider business mailing address

5645 FRIARS RD UNIT 360
SAN DIEGO CA
92110-2536
US

V. Phone/Fax

Practice location:
  • Phone: 256-795-2559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: