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General NPI Number Information
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NPI Number | 1902145188
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Entity Type | Organization
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Legal Business Name | KEVIN GERARD KELLY
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 13150 HIGHWAY 43 SUITE 10
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-4558
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Country | US
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Telephone | 256-332-5901
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Fax | 256-332-6911
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Provider Business Mailing Address
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Address Line | 13150 HIGHWAY 43 SUITE 10
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-4558
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Country | US
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Telephone | 256-332-5901
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Fax | 256-332-6911
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN GERARD KELLY
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Credential | M.D.
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Telephone | 256-332-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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