Individual
KELLI GILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1083 E RELHAM DR, LOXLEY, AL 36551-2406
(251) 964-4011
(251) 964-4012
Mailing address
1303 DR MARTIN L KING JR AVE, MOBILE, AL 36603-5341
(251) 432-4117
(251) 436-7765
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-132253
AL
363LA2200X
Adult Health Nurse Practitioner
1-132253
AL
363LC1500X
Community Health Nurse Practitioner
1-132253
AL
363LF0000X
Family Nurse Practitioner
1-132253
AL
363LP0200X
Pediatric Nurse Practitioner
1-132253
AL
363LP2300X
Primary Care Nurse Practitioner
1-132253
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-132253
STATE LICENSE
AL
Enumeration date
03/17/2016
Last updated
03/17/2016
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