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General NPI Number Information
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NPI Number | 1649388513
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Entity Type | Individual
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Provider Name | KATHLEEN M KELLEY PNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 1952 LONG GROVE DR SUITE 202
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-971-2992
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Fax | 843-971-2998
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Provider Business Mailing Address
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Address Line | 2051 CHARLIE HALL BLVD
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City | CHARLESTON
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State | SC
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Zip | 29414
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Country | US
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Telephone | 843-573-2535
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Fax | 843-573-2534
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1877
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License Number State | SC
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