Healthcare Provider Details

I. General information

NPI: 1457015703
Provider Name (Legal Business Name): KELCIE RENAE THAMES DNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 DOCTORS CT
ROXBORO NC
27573-4571
US

IV. Provider business mailing address

796 DOCTORS CT
ROXBORO NC
27573-4571
US

V. Phone/Fax

Practice location:
  • Phone: 336-598-0002
  • Fax: 336-599-2159
Mailing address:
  • Phone: 336-598-0002
  • Fax: 336-599-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10210943
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: