Provider Demographics
NPI:1609242577
Name:KELLY, BEVERLY SHELLEY (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SHELLEY
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1895
Mailing Address - Country:US
Mailing Address - Phone:404-872-8837
Mailing Address - Fax:678-244-2155
Practice Address - Street 1:1801 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1895
Practice Address - Country:US
Practice Address - Phone:404-872-8837
Practice Address - Fax:678-244-2155
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP191024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily