MEDICARE: KELLY TRENT

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	163WC0400X	Case Management Registered Nurse	234526	NC

General Provider Information

NPI Number	:	1235088477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY TRENT

Provider Business Mailing Address
First Line	:	3341 WOODLEAF RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-4736
Country	:	US
Telephone Number	:	980-301-4212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3341 WOODLEAF RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-4736
Country	:	US
Telephone Number	:	980-301-4212
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ KELLY TRENT ” Practice Location

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