Individual
RYAN MICHAEL KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
126 RUE COLETTE, THIBODAUX, LA 70301-5628
(985) 625-0023
(985) 625-0022
Mailing address
126 RUE COLETTE, THIBODAUX, LA 70301-5628
(985) 625-0023
(985) 625-0022
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
214914
LA
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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