Healthcare Provider Details

I. General information

NPI: 1205114865
Provider Name (Legal Business Name): KELLEY H PLANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 KENT RD STE 8
TIFTON GA
31794-1697
US

IV. Provider business mailing address

PO BOX 7083
TIFTON GA
31793-7083
US

V. Phone/Fax

Practice location:
  • Phone: 229-391-2910
  • Fax: 229-238-0953
Mailing address:
  • Phone: 229-391-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP135055
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP135055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: