Provider Demographics
NPI:1306452545
Name:FELL, RICHARD KEITH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEITH
Last Name:FELL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 HIGHWAY 72 W STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9575
Mailing Address - Country:US
Mailing Address - Phone:256-724-3587
Mailing Address - Fax:
Practice Address - Street 1:2785 CARL T JONES DR SE STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4947
Practice Address - Country:US
Practice Address - Phone:256-964-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-076620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily