Individual
NATALIE NICOLE KELLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 HEYWOOD AVENUE SUITE 200, SPARTANBURG, SC 29302
(864) 573-9595
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20315
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3964
—
SC
01
—
SC88064722
MEDICARE PTAN
SC
01
—
SC88066067
MEDICARE PTAN
SC
01
—
SC88066084
MEDICARE PIN
SC
01
—
SC88066121
MEDICARE PTAN
SC
01
—
SCA009J577
MEDICARE PIN
SC
Enumeration date
07/06/2016
Last updated
01/15/2020
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