Provider Demographics
NPI:1427054105
Name:MCALLISTER, KELLI LYNN (FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:MCALLISTER
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7483 S COUNTY ROAD 49
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-6178
Mailing Address - Country:US
Mailing Address - Phone:334-701-5355
Mailing Address - Fax:334-701-5355
Practice Address - Street 1:7483 S COUNTY ROAD 49
Practice Address - Street 2:
Practice Address - City:SLOCOMB
Practice Address - State:AL
Practice Address - Zip Code:36375-6178
Practice Address - Country:US
Practice Address - Phone:334-701-5355
Practice Address - Fax:334-269-7286
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-074149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-0974149OtherSTATE LICENSE
MN10805OtherSTATE LICENSE
FL11025935OtherSTATE LICENSE
GA167880OtherSTATE LICENSE
AL515-41191OtherBLUE CROSS BLUE SHIELD
AL631807046Medicaid
MT220108OtherSTATE LICENSE