Provider Demographics
NPI:1265020283
Name:KELLEY, ALISHA SKYE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:SKYE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 COUNTY ROAD 742
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046-5648
Mailing Address - Country:US
Mailing Address - Phone:205-966-2672
Mailing Address - Fax:
Practice Address - Street 1:1015 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2305
Practice Address - Country:US
Practice Address - Phone:205-280-3248
Practice Address - Fax:205-280-3369
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily