Provider Demographics
NPI:1689307183
Name:KELLEY, NANCY (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:NP
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 791
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0791
Mailing Address - Country:US
Mailing Address - Phone:888-654-8099
Mailing Address - Fax:888-873-9399
Practice Address - Street 1:1125 WEST ST STE 200
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4279
Practice Address - Country:US
Practice Address - Phone:888-654-8099
Practice Address - Fax:888-873-9399
Is Sole Proprietor?:No
Enumeration Date:2022-07-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD814845700Medicaid