MEDICARE: ASHLEY NICOLE O'KELLEY AGPCNP

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	363L00000X	Nurse Practitioner	25941	SC
2	363L00000X	Nurse Practitioner	OKEL-19AEP	NC

General Provider Information

NPI Number	:	1790431492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE O'KELLEY AGPCNP

Provider Business Mailing Address
First Line	:	PO BOX 1420
Second Line	:
City	:	LADSON
State	:	SC
Zip	:	29456-1420
Country	:	US
Telephone Number	:	336-963-5388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2668 LAKE PARK DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-7120
Country	:	US
Telephone Number	:	843-640-3035
Fax Number	:

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

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	06/19/2026

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