Organization
FORT MILL SENIOR WELLNESS LLC
Active
Other names
Self Employed
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI P GAGNE APRN (PRESIDENT)
(860) 346-0252
Entity
Organization
Contact information
Practice address
331 E MAIN ST STE 200, ROCK HILL, SC 29730-5384
(704) 438-0687
(844) 591-0104
Mailing address
331 E MAIN ST STE 200, ROCK HILL, SC 29730-5384
(860) 346-0252
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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