Individual
MRS. DANIELLE RAE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
705 SUMMIT CROSSING PL STE 150, GASTONIA, NC 28054-2137
(704) 671-6300
(704) 671-6307
Mailing address
PO BOX 744786, ATLANTA, GA 30374-4786
(704) 834-2450
(704) 671-5331
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
27745
SC
363LP0200X
Pediatric Nurse Practitioner
Primary
5005940
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053655928
—
NC
Enumeration date
11/16/2012
Last updated
08/17/2023
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