# KELLY BOARD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1649719915
- **Gender:** F
- **Credential:** APRN, NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 0024194779 | VA | — |
| 363LA2200X | Adult Health Nurse Practitioner | 0033314 | OH | — |
| 363LA2200X | Adult Health Nurse Practitioner | 1102491 | TX | — |
| 363LA2200X | Adult Health Nurse Practitioner | 209028496 | IL | — |
| 363LA2200X | Adult Health Nurse Practitioner | 244045 | LA | — |
| 363LA2200X | Adult Health Nurse Practitioner | 29709 | SC | — |
| 363LA2200X | Adult Health Nurse Practitioner | 303204 | AZ | — |
| 363LA2200X | Adult Health Nurse Practitioner | 37319 | TN | — |
| 363LA2200X | Adult Health Nurse Practitioner | 4704272053 | MI | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 5018989 | NC | — |
| 363LA2200X | Adult Health Nurse Practitioner | APRN9482729 | FL | — |
| 363LA2200X | Adult Health Nurse Practitioner | CAPN.0101629 | CO | — |
| 363LA2200X | Adult Health Nurse Practitioner | GAA-NP003047 | GA | — |

## Other

- **Enumeration date:** 02/19/2017
- **Last updated:** 11/28/2025