Provider Demographics
NPI:1558094748
Name:MARTIN, KELLI B (CRNP)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:B
Last Name:MARTIN
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 1:901 LEIGHTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5703
Mailing Address - Country:US
Mailing Address - Phone:256-236-0890
Mailing Address - Fax:256-236-7078
Practice Address - Street 1:901 LEIGHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5703
Practice Address - Country:US
Practice Address - Phone:256-236-0890
Practice Address - Fax:256-236-7078
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily