Individual
HOLLEY NANETTE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4345 NELSON RD, LAKE CHARLES, LA 70605-4119
(337) 480-7900
(337) 480-7901
Mailing address
PO BOX123594, DEPT 2394, DALLAS, TX 75312-3594
(337) 480-7900
(337) 480-7901
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0534293
KS
207Q00000X
Family Medicine Physician
Primary
DO.000350
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2355392
—
LA
Enumeration date
06/22/2007
Last updated
09/14/2016
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