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NPI Code Detail

MEDICARE: KELLI PENNER

MEDICARE: KELLI PENNER
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
1163WM0102XMaternal Newborn Registered Nurse311421NC

General Provider Information

NPI Number : 1639012842
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI PENNER
Provider Business Mailing Address
First Line : 1352 AUGUSTUS BEAMON DR
Second Line :
City : INDIAN TRAIL
State : NC
Zip : 28079-0390
Country : US
Telephone Number : 704-776-2860
Fax Number :
Provider Business Practice Location Address
First Line : 307 TRENT DR
Second Line :
City : DURHAM
State : NC
Zip : 27710-3038
Country : US
Telephone Number : 919-684-4248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ KELLI PENNER ” Practice Location

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