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General NPI Number Information
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NPI Number | 1912671843
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Entity Type | Individual
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Provider Name | MIRANDA KERLEY MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1056 FELTON ST
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City | SUMMERTON
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State | SC
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Zip | 29148-7169
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Country | US
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Telephone | 843-819-4021
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Fax |
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Provider Business Mailing Address
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Address Line | 2544 PRINCESS POND RD
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City | SUMMERTON
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State | SC
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Zip | 29148-8446
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Country | US
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Telephone | 843-609-2033
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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 | 25256
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License Number State | SC
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