| Organization Name: | HENRY ALBERT KELLY JR |
| NPI Number: | 1023404704 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HENRY ALBERT KELLY (MHPA, PH.D) |
| Mailing Address: | 4124 Firwood Ln Apt L Charlotte |
| State: | NC US |
| Postal Code: | 282092724 |
| Phone Number: | 9107475215 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2015 |
| NPI Last Update Date: | 04/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 1046352 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |