Individual
LARRY WAYNE KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1423 PEGER RD, FAIRBANKS, AK 99709-5169
(907) 371-1300
Mailing address
906 KINGDOM COME DR, CUMBERLAND, KY 40823-1547
(606) 508-5204
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
183314
AK
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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