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General NPI Number Information
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NPI Number | 1437135936
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Entity Type | Individual
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Provider Name | AMY ELIZABETH KELLY MD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1655 BEAM AVE NUMBER 102
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1163
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Country | US
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Telephone | 651-770-1385
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Fax | 651-770-0672
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Provider Business Mailing Address
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Address Line | 17 EXCHANGE ST W NUMBER 622
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City | SAINT PAUL
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State | MN
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Zip | 55102-1045
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Country | US
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Telephone | 651-227-9141
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Fax | 651-265-6772
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 46573
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License Number State | MN
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