Healthcare Provider Details

I. General information

NPI: 1447901426
Provider Name (Legal Business Name): JOY M KELLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-5651
  • Fax: 256-429-9411
Mailing address:
  • Phone: 256-975-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-159358
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: