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1487319869
LARRY WAYNE KELLY
FAIRBANKS, AK
NPI
1487319869
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: AK 183314)
Enumeration Date
2021-11-01
Last Update Date
2021-11-01
Business Address
LARRY WAYNE KELLY PMHNP
1423 PEGER RD
FAIRBANKS, AK 99709-5169
Phone number: 907-371-1300
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Mailing Address
LARRY WAYNE KELLY PMHNP
906 KINGDOM COME DR
CUMBERLAND, KY 40823-1547
Phone number: 606-508-5204
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