Healthcare Provider Details

I. General information

NPI: 1871975847
Provider Name (Legal Business Name): AMBER KELLY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FORSYTHE AVE
MONROE LA
71201-3014
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6800
  • Fax: 318-966-6801
Mailing address:
  • Phone: 318-966-6800
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number08378
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: