Healthcare Provider Details

I. General information

NPI: 1447245089
Provider Name (Legal Business Name): MELINDA SUE KELLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S MAIN ST HEALTHCARE PLACE AT BETHUNE
BETHUNE SC
29009
US

IV. Provider business mailing address

39 KELLEY LN
SOCIETY HILL SC
29593-5284
US

V. Phone/Fax

Practice location:
  • Phone: 843-334-6551
  • Fax: 843-334-6583
Mailing address:
  • Phone: 843-378-9199
  • Fax: 843-334-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 2434
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: