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Individual

TINA MARIE KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
433 COPPERFIELD BLVD NE, CONCORD, NC 28025-2405
(704) 786-7770
(704) 971-0035
Mailing address
1300 BAXTER ST, STE 215, CHARLOTTE, NC 28204-3053
(704) 332-0396
(704) 971-0035

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
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