Individual
KELLEY ANN ROSEBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
704 GOLD HILL RD, SUITE 1200, FORT MILL, SC 29715-8906
(704) 667-3380
(704) 667-3381
Mailing address
PO BOX 602148, CHARLOTTE, NC 28260-2148
(704) 667-3380
(704) 667-3381
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
19252
SC
363L00000X
Nurse Practitioner
212050
NC
363LF0000X
Family Nurse Practitioner
0050-02423
NC
363LF0000X
Family Nurse Practitioner
Primary
19252
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376682195
—
NC
05
—
7004104
—
NC
05
—
NP1197
—
SC
Enumeration date
02/06/2007
Last updated
02/22/2017
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