Provider Demographics
NPI:1093150039
Name:KELLEY, AMBER F (LAC,DIPLAC, MOM)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:F
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LAC,DIPLAC, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 COUNTY ROAD 42 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6911
Mailing Address - Country:US
Mailing Address - Phone:952-746-1480
Mailing Address - Fax:952-746-1480
Practice Address - Street 1:2500 COUNTY ROAD 42 W
Practice Address - Street 2:SUITE 100
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6911
Practice Address - Country:US
Practice Address - Phone:952-746-1480
Practice Address - Fax:952-746-1480
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist