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General NPI Number Information
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NPI Number | 1912380296
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Entity Type | Individual
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Provider Name | KELSEY RAE GERUGHTY APRN
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Gender | Female
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Dates
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Enumeration Date | 07/03/2015
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 9302 MEDICAL PLAZA DRIVE, SUITE C LTC HEALTH SOLUTIONS
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City | N. CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 864-751-6424
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Fax | 864-751-6430
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Provider Business Mailing Address
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Address Line | 1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 803-454-0365
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Fax | 803-404-6000
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3009576
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License Number State | KY
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