Individual
TINA MARIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
17538
SC
363L00000X
Nurse Practitioner
Primary
5005521
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006561
—
NC
Enumeration date
06/21/2011
Last updated
12/04/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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