Individual
TIMOTHY L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169
(803) 935-8292
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 791-2203
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
219
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0930
—
SC
Enumeration date
12/02/2005
Last updated
09/15/2025
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