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General NPI Number Information
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NPI Number | 1659321487
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Entity Type | Individual
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Provider Name | MARLENE M. KELLY RN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SWCMHC/CLARENDON CMHC, 215 COMMERCE ST.
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City | MANNING
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State | SC
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Zip | 29102
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Country | US
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Telephone | 803-435-2124
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Fax | 803-435-8113
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Provider Business Mailing Address
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Address Line | SWCMHC, 215 N. MAGNOLIA ST.
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City | SUMTER
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State | SC
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Zip | 29151-1946
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Country | US
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Telephone | 803-775-9364
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Fax | 803-773-6615
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | R26774
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License Number State | SC
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