| Kevin G. Kelly, M.d. | |
|
13150 Highway 43 Suite 10 Russellville AL 35653-4558 | |
| (256) 332-5901 | |
| (256) 332-6911 |
| Full Name | Kevin G. Kelly, M.d. |
|---|---|
| Speciality | Family Medicine |
| Location | 13150 Highway 43, Russellville, Alabama |
| Authorized Official Name and Position | Kevin G. Kelly (OWNER) |
| Authorized Official Contact | 2563325901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin G. Kelly, M.d. 13150 Highway 43 Suite 10 Russellville AL 35653-4558 Ph: (256) 332-5901 | Kevin G. Kelly, M.d. 13150 Highway 43 Suite 10 Russellville AL 35653-4558 Ph: (256) 332-5901 |
| NPI Number | 1770887945 |
|---|---|
| Provider Enumeration Date | 01/03/2011 |
| Last Update Date | 01/03/2011 |
| Medicare PECOS PAC ID | 8426209578 |
|---|---|
| Medicare Enrollment ID | O20121119000329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770887945 | NPI | - | NPPES |
| 000001253 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 8497 (Alabama) | Primary |
| Provider Name | Nataline Evelyn Pennington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497297493 PECOS PAC ID: 7810271897 Enrollment ID: I20170313001164 |
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