MEDICARE: MRS. KELLY LYNN TOLCHER RNCPHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN119473 NP RNCPHP	GA
2	363L00000X	Nurse Practitioner	5019099	NC

General Provider Information

NPI Number	:	1194982371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY LYNN TOLCHER RNCPHP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 GILLMAN RD STE 200A
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7922
Country	:	US
Telephone Number	:	704-316-5287
Fax Number	:	704-316-5268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	12/13/2023

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