MEDICARE: KEVIN P KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	HC3111	NC

General Provider Information

NPI Number	:	1568778033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN P KELLY

Provider Business Mailing Address
First Line	:	3975A MARKET ST
Second Line	:	COMFORT KEEPERS
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1403
Country	:	US
Telephone Number	:	910-342-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3975A MARKET ST
Second Line	:	COMFORT KEEPERS
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1403
Country	:	US
Telephone Number	:	910-342-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	08/27/2010

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Directions to “ KEVIN P KELLY ” Practice Location

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