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NPI Code Detail

MEDICARE: MRS. OLIVIA HENDERSON KELLEY NP

MEDICARE: MRS. OLIVIA HENDERSON KELLEY NP
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
1363L00000XNurse PractitionerAPRN-NP280847GA

General Provider Information

NPI Number : 1770470676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OLIVIA HENDERSON KELLEY NP
Provider Business Mailing Address
First Line : 8344 FRANK HOUSER AVE UNIT 1625
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-2673
Country : US
Telephone Number : 706-392-9770
Fax Number :
Provider Business Practice Location Address
First Line : 710 CENTER ST
Second Line :
City : COLUMBUS
State : GA
Zip : 31901-1527
Country : US
Telephone Number : 706-571-1454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2025
Last Update Date : 02/03/2026

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