MEDICARE: KELLY BELLIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-194619	AL

General Provider Information

NPI Number	:	1306227061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BELLIS RN

Provider Business Mailing Address
First Line	:	191 OLDWOOD RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-8504
Country	:	US
Telephone Number	:	816-590-3899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 MEMORIAL PKWY SW STE C
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1396
Country	:	US
Telephone Number	:	816-590-3899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	05/08/2023

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