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Individual

KEVIN GERARD KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
13150 HIGHWAY 43, SUITE 10, RUSSELLVILLE, AL 35653-4558
(256) 332-5901
(256) 332-6911
Mailing address
13150 HIGHWAY 43, SUITE 10, RUSSELLVILLE, AL 35653-4558
(256) 332-5901
(256) 332-6911

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8497
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000001253
AL
Enumeration date
09/20/2005
Last updated
03/28/2014
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