Provider Demographics
NPI:1922674035
Name:FRY, KELLEY DANIELLE (MSN, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:DANIELLE
Last Name:FRY
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1112
Mailing Address - Country:US
Mailing Address - Phone:659-599-9512
Mailing Address - Fax:
Practice Address - Street 1:1989 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1112
Practice Address - Country:US
Practice Address - Phone:659-599-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143836208D00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice