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General NPI Number Information
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NPI Number | 1912317629
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Entity Type | Individual
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Provider Name | LISA A. KELLY APRN,NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 12 KANAWHA TER
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2750
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Country | US
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Telephone | 304-201-1130
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Fax | 304-201-1134
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Provider Business Mailing Address
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Address Line | 97 GREAT TEAYS BLVD STE 6
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City | SCOTT DEPOT
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State | WV
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Zip | 25560-9816
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Country | US
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Telephone | 304-757-6999
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Fax | 304-201-5019
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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 | 59915
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License Number State | WV
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