Healthcare Provider Details

I. General information

NPI: 1255067484
Provider Name (Legal Business Name): KELSIE KLINK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 WOODLAND AVE
MOUNT PLEASANT SC
29464-3288
US

IV. Provider business mailing address

1241 WOODLAND AVE
MT PLEASANT SC
29464-3288
US

V. Phone/Fax

Practice location:
  • Phone: 843-824-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26305
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26305
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: