Provider Demographics
NPI:1881731917
Name:HALL, KELLY MCCLELLAN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCCLELLAN
Last Name:HALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:705 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4113
Mailing Address - Country:US
Mailing Address - Phone:334-289-0225
Mailing Address - Fax:334-287-3340
Practice Address - Street 1:705 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4113
Practice Address - Country:US
Practice Address - Phone:334-289-0225
Practice Address - Fax:334-287-3340
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily