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Individual

PORNPILAI KECK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
108 PROVIDENCE RD, CHARLOTTE, NC 28207-1218
(336) 481-8655
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 481-8655
(336) 277-9165

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5020321
NC
363LA2200X
Adult Health Nurse Practitioner
F307124
NY

Other

Enumeration date
09/01/2015
Last updated
09/30/2025
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