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NPI Code Detail

MEDICARE: KELLI P GAGNE APRN

MEDICARE: KELLI P GAGNE APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4815CT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5008661NC
3363LP0808XPsychiatric/Mental Health Nurse Practitioner20033SC

General Provider Information

NPI Number : 1861775264
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI P GAGNE APRN
Provider Business Mailing Address
First Line : 331 E MAIN ST STE 200
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-5384
Country : US
Telephone Number : 704-438-0687
Fax Number : 844-308-7996
Provider Business Practice Location Address
First Line : 331 E MAIN ST STE 200
Second Line :
City : ROCK HILL
State : SC
Zip : 29730-5384
Country : US
Telephone Number : 704-438-0687
Fax Number : 844-308-7996
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 09/20/2022

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