Individual
MS. KELLY M BISTLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1401 MAIN ST, BONNEAU, SC 29431-5013
(843) 825-3404
(843) 825-3407
Mailing address
1401 MAIN ST, BONNEAU, SC 29431-5013
(843) 825-3404
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26733
SC
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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