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General NPI Number Information
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NPI Number | 1578850947
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Entity Type | Individual
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Provider Name | KELLY LYNN WARNOCK FNP
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Gender | Female
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 1165 HIGHWAY 1 S SUITE 300
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City | LUGOFF
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State | SC
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Zip | 29078-8966
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Country | US
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Telephone | 803-438-0867
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Fax | 803-438-4391
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Provider Business Mailing Address
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Address Line | 103 SOUTH MAIN STREET
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City | BETHUNE
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State | SC
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Zip | 29009
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Country | US
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Telephone | 843-334-6551
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Fax | 803-438-4391
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F4476
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License Number State | SC
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