| NPI | 1417518614 |
|---|---|
| Former Name | MARILYN LOUISE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN103976FNP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 94648) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-08-16 |