Healthcare Provider Details

I. General information

NPI: 1316066079
Provider Name (Legal Business Name): KELLIE HARNEY O'HARA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N NC 16 BUSINESS HWY STE 104
DENVER NC
28037-3002
US

IV. Provider business mailing address

275 N NC 16 BUSINESS HWY STE 104
DENVER NC
28037-3002
US

V. Phone/Fax

Practice location:
  • Phone: 704-489-3440
  • Fax: 888-815-0892
Mailing address:
  • Phone: 704-489-3440
  • Fax: 888-815-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5002520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: