Provider Demographics
NPI:1629946199
Name:KELLY, AMBER NICOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VIEW ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-1762
Mailing Address - Country:US
Mailing Address - Phone:304-613-5598
Mailing Address - Fax:
Practice Address - Street 1:120 VIEW ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1762
Practice Address - Country:US
Practice Address - Phone:304-613-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant