Provider Demographics
NPI:1316494636
Name:SADLER, KELLY WILLIAM (NP-C)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:WILLIAM
Last Name:SADLER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 GREENO RD N
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2979
Mailing Address - Country:US
Mailing Address - Phone:251-928-2401
Mailing Address - Fax:251-928-5099
Practice Address - Street 1:341 GREENO RD N
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2979
Practice Address - Country:US
Practice Address - Phone:251-928-2401
Practice Address - Fax:251-928-5099
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-133352363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care