| Doctor Name: | KELLY KELLY |
| NPI Number: | 1003228446 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 28184683A |
| Business Practice Address: | 4100 Covert Ave Evansville, IN - 477145559 |
| Business Phone Number: | 8124769983 |
| Business Fax Number: | 8124376149 |
| Mailing Address: | Po Box 398, NEWBURGH |
| State: | IN |
| Postal Code: | 476290398 |
| Phone Number: | 8124769983 |
| Fax Number: | 8124376149 |
| NPI Enumeration Date: | 05/20/2014 |
| NPI Last Update Date: | 07/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 28184683A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |