Healthcare Provider Details

I. General information

NPI: 1750130902
Provider Name (Legal Business Name): MEGHAN KELLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEMORIAL DR STE A
JESUP GA
31545-0134
US

IV. Provider business mailing address

3425 NELLIE ST
PATTERSON GA
31557-5090
US

V. Phone/Fax

Practice location:
  • Phone: 912-559-2337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN302899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: