Provider Demographics
NPI:1669448866
Name:KELLY, CARMALITA (CRNP)
Entity Type:Individual
Prefix:
First Name:CARMALITA
Middle Name:
Last Name:KELLY
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-533-1600
Mailing Address - Fax:256-539-0856
Practice Address - Street 1:201 GOVERNORS DR SW
Practice Address - Street 2:FLOOR 1
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5170
Practice Address - Country:US
Practice Address - Phone:256-533-1600
Practice Address - Fax:256-539-0856
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083967363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
051557216KELMedicare ID - Type Unspecified
Q62857Medicare UPIN