Healthcare Provider Details

I. General information

NPI: 1952228181
Provider Name (Legal Business Name): BIANCA DENISE KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S ARENDELL AVE
ZEBULON NC
27597-2809
US

IV. Provider business mailing address

PO BOX 612
ZEBULON NC
27597-0612
US

V. Phone/Fax

Practice location:
  • Phone: 252-885-9694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: