MEDICARE: AMY S KELLEY BSN,AAPS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	AAPS	KS

General Provider Information

NPI Number	:	1447493499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY S KELLEY BSN,AAPS

Provider Business Mailing Address
First Line	:	1721 E OSAGE RD
Second Line	:	SUITE 200
City	:	DERBY
State	:	KS
Zip	:	67037-2092
Country	:	US
Telephone Number	:	316-788-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E OSAGE RD
Second Line	:	SUITE 200
City	:	DERBY
State	:	KS
Zip	:	67037-2092
Country	:	US
Telephone Number	:	316-788-1800
Fax Number	:	316-788-1815

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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