Basic Information
| Provider Information | |||||||||
| NPI: | 1447245089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 KELLEY LN | ||||||||
| Address2: | |||||||||
| City: | SOCIETY HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295935284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433789199 | ||||||||
| FaxNumber: | 8433346583 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 S MAIN ST | ||||||||
| Address2: | HEALTHCARE PLACE AT BETHUNE | ||||||||
| City: | BETHUNE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433346551 | ||||||||
| FaxNumber: | 8433346583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN 2434 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.