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General NPI Number Information
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NPI Number | 1558605337
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Entity Type | Individual
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Provider Name | CHRISTOPHER W. KELLY FNP-C APRN, MSN, MSM
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Gender | Male
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 42D MEDICAL GROUP 300 S. TWINING ST BLDG 760
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City | MAXWELL AFB
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State | AL
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Zip | 36112-6027
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Country | US
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Telephone | 334-953-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 300 TWINING ST BLDG 760
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City | MAXWELL AFB
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State | AL
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Zip | 36112-6027
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Country | US
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Telephone | 334-953-5143
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 44039
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License Number State | WY
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