Individual
MELISSA KELLUM PARENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
169 ASHLEY AVE, CHARLESTON, SC 29425-8905
(843) 792-2123
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
19559
SC
Other
Enumeration date
06/26/2015
Last updated
10/28/2020
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