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General NPI Number Information
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NPI Number | 1982656674
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Entity Type | Individual
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Provider Name | AMBER LEE KELLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 954 N SAMUEL MOORE PKWY STE C
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City | MOORESVILLE
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State | IN
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Zip | 46158-1475
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Country | US
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Telephone | 317-834-5466
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Fax | 317-584-3794
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000324A
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License Number State | IN
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