Healthcare Provider Details

I. General information

NPI: 1083550479
Provider Name (Legal Business Name): COLBY KALEE BOUNDS-SELLERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BREVARD PKWY
LEXINGTON SC
29073-7265
US

IV. Provider business mailing address

105 BREVARD PKWY
LEXINGTON SC
29073-7265
US

V. Phone/Fax

Practice location:
  • Phone: 803-951-1880
  • Fax: 803-951-0384
Mailing address:
  • Phone: 803-951-1880
  • Fax: 803-951-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number31807
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: