Healthcare Provider Details

I. General information

NPI: 1649180506
Provider Name (Legal Business Name): TONYA CHERESE KELLY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 MEDLIN RD
MONROE NC
28112-7483
US

IV. Provider business mailing address

4019 MEDLIN RD
MONROE NC
28112-7483
US

V. Phone/Fax

Practice location:
  • Phone: 910-398-2239
  • Fax:
Mailing address:
  • Phone: 910-398-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32747
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: