Provider Demographics
NPI:1891302543
Name:KELLEY, ALLISON (BS, CLC, CPST)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BS, CLC, CPST
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, CLC, CPST
Mailing Address - Street 1:28 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-2252
Mailing Address - Country:US
Mailing Address - Phone:601-946-6100
Mailing Address - Fax:
Practice Address - Street 1:28 BAKER ST
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-2252
Practice Address - Country:US
Practice Address - Phone:601-946-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty