Provider Demographics
NPI:1164822987
Name:MATHERLY, KELLY LYNNE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNNE
Last Name:MATHERLY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3141
Mailing Address - Country:US
Mailing Address - Phone:304-253-3000
Mailing Address - Fax:304-255-7884
Practice Address - Street 1:379 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3141
Practice Address - Country:US
Practice Address - Phone:304-253-3000
Practice Address - Fax:304-255-7884
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN61813NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily