Individual
KELLY COURTNEY SHADWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2817 ROCK MERITT AVE, FORT LIBERTY, NC 28310-1182
(910) 907-6982
(803) 328-1865
Mailing address
2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER, FORT LIBERTY, NC 28310-0001
(910) 907-8922
(910) 907-6069
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
12332
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1456498
WELLCARE OF SC
SC
01
—
19QFR
BCBSNC
NC
05
—
SA1792
—
SC
Enumeration date
07/19/2010
Last updated
10/15/2024
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