Individual
JAMES PATRICK THOMAS KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1200 E MAIN ST STE 12, SPARTANBURG, SC 29307-1738
(864) 560-9260
(864) 560-9265
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
22319
SC
363LF0000X
Family Nurse Practitioner
Primary
22319
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5742
—
SC
01
—
SCE6826067
MEDICARE PIN
SC
01
—
SCE6826084
MEDICARE PIN
SC
01
—
SCE6826121
MEDICARE PIN
SC
01
—
SCE682J577
MEDICARE PIN
SC
Enumeration date
02/06/2019
Last updated
01/28/2021
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