Healthcare Provider Details

I. General information

NPI: 1316332786
Provider Name (Legal Business Name): KELLY HERRINGDINE C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

IV. Provider business mailing address

242A 9TH AVENUE DR NE
HICKORY NC
28601-3828
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3400
  • Fax:
Mailing address:
  • Phone: 828-327-6673
  • Fax: 828-327-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1141093
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2294
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3009380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: