Individual
KELLY BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2111 WILSON RD, NEWBERRY, SC 29108-1603
(803) 321-2170
Mailing address
2112 PINE HILL CIR, NEWBERRY, SC 29108-1628
(803) 924-3017
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
103975
SC
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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