Healthcare Provider Details

I. General information

NPI: 1477479475
Provider Name (Legal Business Name): KELLI STOVALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 COLUMBUS ST
SUN PRAIRIE WI
53590-3901
US

IV. Provider business mailing address

18075 MICHELLE LN
ATHENS AL
35613-5538
US

V. Phone/Fax

Practice location:
  • Phone: 608-977-2057
  • Fax: 608-977-2057
Mailing address:
  • Phone: 501-617-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD07888
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: