Provider Demographics
NPI:1700290079
Name:PAPARELLA, KELLY LISENBE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LISENBE
Last Name:PAPARELLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 MARIA AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4024
Mailing Address - Country:US
Mailing Address - Phone:334-341-9525
Mailing Address - Fax:
Practice Address - Street 1:218 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:AL
Practice Address - Zip Code:36446-0065
Practice Address - Country:US
Practice Address - Phone:334-636-4823
Practice Address - Fax:334-636-1702
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner