Individual
KELLY BERGERON CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
612 MOCKSVILLE AVE, SALISBURY, NC 28144-2732
(704) 210-5260
(704) 210-5265
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 210-5260
(704) 210-5265
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5002933
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760507958
—
NC
01
—
182E4
BCBS
NC
01
—
NCE536B
MEDICARE
NC
01
—
P02479422
RAILROAD MEDICARE
NC
Enumeration date
03/20/2007
Last updated
05/29/2024
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