Healthcare Provider Details

I. General information

NPI: 1376115873
Provider Name (Legal Business Name): KELLI KELLEY DNP-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MORGANTON BLVD SW
LENOIR NC
28645-5823
US

IV. Provider business mailing address

602 MORGANTON BLVD SW
LENOIR NC
28645-5823
US

V. Phone/Fax

Practice location:
  • Phone: 828-850-7094
  • Fax: 833-449-4125
Mailing address:
  • Phone: 828-239-9400
  • Fax: 833-449-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberKELL-9IQPN
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: