Healthcare Provider Details

I. General information

NPI: 1922038751
Provider Name (Legal Business Name): KELLEY BORELLA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 6TH AVE S
BIRMINGHAM AL
35233-1601
US

IV. Provider business mailing address

3000 MEADOW LAKE DR SUITE 101
BIRMINGHAM AL
35242-0301
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-3200
  • Fax: 205-521-5529
Mailing address:
  • Phone: 205-995-1009
  • Fax: 205-995-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-098614
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: