Individual
KELLY WALTON TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
111 E 3RD AVE, GASTONIA, NC 28052-4317
(704) 874-3300
(704) 874-0065
Mailing address
PO BOX 604050, CHARLOTTE, NC 28260-4050
(980) 330-6808
(980) 330-6938
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5020562
NC
363LF0000X
Family Nurse Practitioner
Primary
5020562
NC
Other
Enumeration date
07/31/2024
Last updated
09/16/2025
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