Provider Demographics
NPI:1285107318
Name:KELLY, TALPHINETA ALISHA (NP-BC)
Entity type:Individual
Prefix:MRS
First Name:TALPHINETA
Middle Name:ALISHA
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 STONEMILL MNR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8221
Mailing Address - Country:US
Mailing Address - Phone:719-492-9077
Mailing Address - Fax:
Practice Address - Street 1:493 STONEMILL MNR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8221
Practice Address - Country:US
Practice Address - Phone:719-492-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902999363LF0000X
GA299338363LF0000X
LA202029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily