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General NPI Number Information
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NPI Number | 1497181218
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Entity Type | Individual
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Provider Name | CHARMAINE MARIE KELLY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 670 BOULEVARD DE FRANCE BRANCH HEALTH CLINIC
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City | PORT ROYAL
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State | SC
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Zip | 29902-6122
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Country | US
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Telephone | 843-228-4237
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Fax |
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Provider Business Mailing Address
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Address Line | 72700 DINAH SHORE DR STE 200
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City | PALM DESERT
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State | CA
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Zip | 92211-0859
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Country | US
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Telephone | 909-825-7084
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Fax | 909-422-3002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 53952
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License Number State | CA
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