| Doctor Name: | VICKI AMANDA KELLEY |
| NPI Number: | 1093130791 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | 1-101347 |
| Business Practice Address: | 847 Boll Weevil Cir Suite 110 Enterprise, AL - 363302472 |
| Business Phone Number: | 3344894110 |
| Business Fax Number: | 3344894165 |
| Mailing Address: | 104 Medical Dr, DOTHAN |
| State: | AL |
| Postal Code: | 363036902 |
| Phone Number: | 3346719445 |
| Fax Number: | 3348360059 |
| NPI Enumeration Date: | 03/04/2014 |
| NPI Last Update Date: | 03/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1-101347 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |