Provider Demographics
NPI:1689287070
Name:PETROVICS, KELLY MILES (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MILES
Last Name:PETROVICS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:985 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4500
Mailing Address - Country:US
Mailing Address - Phone:205-481-7312
Mailing Address - Fax:205-481-7593
Practice Address - Street 1:1001 BROCKS GAP PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4028
Practice Address - Country:US
Practice Address - Phone:205-421-1032
Practice Address - Fax:205-421-1040
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-158612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily