Provider Demographics
NPI:1023585569
Name:KELLAMS, ALYSSA BROOKE (NP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:BROOKE
Last Name:KELLAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S BALLARD LN
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-9351
Mailing Address - Country:US
Mailing Address - Phone:812-528-2351
Mailing Address - Fax:
Practice Address - Street 1:2418 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3049
Practice Address - Country:US
Practice Address - Phone:812-508-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008512A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily