Basic Information
| Provider Information | |||||||||
| NPI: | 1578850947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNOCK | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 SOUTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BETHUNE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433346551 | ||||||||
| FaxNumber: | 8034384391 | ||||||||
| Practice Location | |||||||||
| Address1: | 1165 HIGHWAY 1 S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LUGOFF | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290788966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034380867 | ||||||||
| FaxNumber: | 8034384391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2011 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F4476 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.