Provider Demographics
NPI:1003998873
Name:KELLEY, DIANE LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1276 NORTH LOCUST AVE.
Mailing Address - Street 2:FIRST FLOOR SUITE D
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-4425
Mailing Address - Country:US
Mailing Address - Phone:931-766-7056
Mailing Address - Fax:931-766-7057
Practice Address - Street 1:1276 NORTH LOCUST AVE.
Practice Address - Street 2:FIRST FLOOR SUITE D
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-4425
Practice Address - Country:US
Practice Address - Phone:931-766-7056
Practice Address - Fax:931-766-7057
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1040028363LF0000X
TN13178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily