Provider Demographics
NPI:1548752520
Name:KELLY, WILLIAM F
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:KELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. MARY'S
Mailing Address - State:AK
Mailing Address - Zip Code:99658
Mailing Address - Country:US
Mailing Address - Phone:907-438-3500
Mailing Address - Fax:907-438-3540
Practice Address - Street 1:310 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:ST. MARY'S
Practice Address - State:AK
Practice Address - Zip Code:99658
Practice Address - Country:US
Practice Address - Phone:907-438-3500
Practice Address - Fax:907-438-3540
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker