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General NPI Number Information
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NPI Number | 1053849166
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Entity Type | Individual
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Provider Name | NICOLE SHAVON KELLY PHD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11 MISTY WOOD CIR APT H
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City | TIMONIUM
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State | MD
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Zip | 21093-1338
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Country | US
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Telephone | 443-949-2008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20093
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City | TOWSON
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State | MD
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Zip | 21284-0093
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Country | US
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Telephone | 443-949-2008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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