Healthcare Provider Details

I. General information

NPI: 1083082499
Provider Name (Legal Business Name): KELLIAN R KELLY APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

325 MAINE STREET MSO LIBRARY
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-6000
  • Fax: 785-270-0086
Mailing address:
  • Phone: 785-505-2988
  • Fax: 785-270-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76919
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76919-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: