Individual
MRS. KELLY JEANNE CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5085 MORGANTON RD, FAYETTEVILLE, NC 28314-1523
(910) 323-3890
(910) 323-4509
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5012788
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396376380
—
NC
01
—
NNB501A
MEDICARE PTAN
NC
01
—
NNB501B
MEDICARE PTAN
NC
Enumeration date
01/29/2020
Last updated
10/30/2023
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