Ethel Mae Kelley

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

RN3191402 Issued in FL

Practice address

229 S Davis Rd Ste 900
Lagrange, GA 30241-2609

Phone

(706) 756-1489

NPI assigned

Mar 30, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crossroads Treatment Center of Lagrange, PC

  • Community/Behavioral Health Agency
  • Lagrange, GA
  • NPI 1588102438
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1023712163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 S DAVIS RD STE 900",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302412609",
            "telephone_number": "706-756-1489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 S DAVIS RD STE 900",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302412609",
            "telephone_number": "706-756-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "ETHEL",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "RN3191402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dara Whitney Kagan, PHARMD
• Ravi Kumar Kamepalli, M.D.
• Tammi Kaminsky, D.C.
• Shih Yin Anna Kao, M.D.
• Manish C Kataria, RPH
• Cassie Jo Kelly, FNP
• Miriam Kelly, LPC
• Karen Armstrong Kennedy, DMD
• John Herbert Kent Jr., DC
• Douglas Brent Kersey Jr., DMD

• Addiction (Substance Use Disorder) Registered Nurse in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.