Healthcare Provider Details

I. General information

NPI: 1912317629
Provider Name (Legal Business Name): LISA A. KELLY APRN,NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA A. MESSER

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KANAWHA TER
SAINT ALBANS WV
25177-2750
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9816
US

V. Phone/Fax

Practice location:
  • Phone: 304-201-1130
  • Fax: 304-201-1134
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-201-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59915
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: