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General NPI Number Information
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NPI Number | 1790260453
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Entity Type | Individual
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Provider Name | MORGAN MATTINGLY KELLEY
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 3001 NEWCASTLE LOOP
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-4502
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Country | US
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Telephone | 843-887-7546
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Fax | 854-588-6246
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Provider Business Mailing Address
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Address Line | 33 GASPARILLA CIR
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City | MURRELLS INLET
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State | SC
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Zip | 29576-4814
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Country | US
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Telephone | 843-340-8050
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Fax |
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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 | 22203
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License Number State | SC
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