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NPI Code Detail

MEDICARE: ERIN ELIZABETH KELLY NP

MEDICARE:   ERIN ELIZABETH KELLY  NP
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
1363LA2200XAdult Health Nurse Practitioner5006073NC
2363L00000XNurse Practitioner5006073NC

General Provider Information

NPI Number : 1801964697
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN ELIZABETH KELLY NP
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6915 VILLAGE MEDICAL CIR
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8002
Country : US
Telephone Number : 336-893-1527
Fax Number : 336-893-1596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 06/02/2022

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