Provider Demographics
NPI:1699257956
Name:KELLEY, CRYSTAL ANGELIC (DNP, FNP-C, WHNP-BC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANGELIC
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DNP, FNP-C, WHNP-BC
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:ANGELIC
Other - Last Name:ULLAURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, WHNP-BC
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:717-332-1126
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:912-315-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003892363LF0000X
VA0001216043163W00000X
MDAC003880363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health