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Individual
KELLY C. STEGALL
Active
Individual
KELLY C. STEGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN181599
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01368785
AMERIGROUP
GA
05
—
839184162A
—
GA
05
—
839184162B
—
GA
05
—
NP1638
—
SC
01
—
P00869909
RR MEDICARE
GA
Enumeration date
06/10/2010
Last updated
08/09/2018
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