Healthcare Provider Details

I. General information

NPI: 1780591149
Provider Name (Legal Business Name): PRECIOUS KELLY MSN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WOODMONT LN NW STE 2636
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

1445 WOODMONT LN NW STE 2636
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 470-851-6399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP272275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: