Provider Demographics
NPI:1043787526
Name:KELLY, ZANE PENTON (CRNP)
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:PENTON
Last Name:KELLY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HERREN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1276
Mailing Address - Country:US
Mailing Address - Phone:334-283-3477
Mailing Address - Fax:334-283-4162
Practice Address - Street 1:115 HERREN HILL RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1276
Practice Address - Country:US
Practice Address - Phone:334-283-3477
Practice Address - Fax:334-283-4162
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine