1427054105 NPI number — DR. KELLI LYNN MCALLISTER FNP-BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427054105 NPI number — DR. KELLI LYNN MCALLISTER FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCALLISTER
Provider First Name:
KELLI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427054105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7483 S COUNTY ROAD 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLOCOMB
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36375-6178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-701-5355
Provider Business Mailing Address Fax Number:
334-701-5355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7483 S COUNTY ROAD 49
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLOCOMB
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36375-6178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-701-5355
Provider Business Practice Location Address Fax Number:
334-269-7286
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-074149 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-0974149 . This is a "STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 10805 . This is a "STATE LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 11025935 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 167880 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 515-41191 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631807046 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220108 . This is a "STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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