Provider Demographics
NPI:1699586008
Name:KELLEY, LINDY (RN)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26144 COUNTY ROAD 87
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:AL
Mailing Address - Zip Code:36263-4421
Mailing Address - Country:US
Mailing Address - Phone:256-926-9875
Mailing Address - Fax:
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-812-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-163575163WI0500X, 163WI0600X, 171400000X, 171400000X, 163WS0121X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No171400000XOther Service ProvidersHealth & Wellness Coach
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery