MEDICARE: KELSIE MAKENNA LANG RICKEY

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	363LF0000X	Family Nurse Practitioner	C-APN.0103575-C-NP	CO
2	363LF0000X	Family Nurse Practitioner	122070	WV
3	363LF0000X	Family Nurse Practitioner	1-146246	AL

General Provider Information

NPI Number	:	1912405820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE MAKENNA LANG RICKEY

Provider Business Mailing Address
First Line	:	5529 12TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35222-4140
Country	:	US
Telephone Number	:	256-606-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 ACTON RD STE 153
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2939
Country	:	US
Telephone Number	:	205-379-0174
Fax Number	:	888-219-8102

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	07/10/2025

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Directions to “ KELSIE MAKENNA LANG RICKEY ” Practice Location

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