Healthcare Provider Details

I. General information

NPI: 1881939031
Provider Name (Legal Business Name): KELLY ARASHIN BOUTHILLET APRN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NORTHRIDGE DR
HILTON HEAD ISLAND SC
29926-3764
US

IV. Provider business mailing address

15 NORTHRIDGE DR
HILTON HEAD SC
29926-3764
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-6612
  • Fax:
Mailing address:
  • Phone: 843-681-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN17947
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17947
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN158158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: