Provider Demographics
NPI:1033777560
Name:BARRINGTON, KELLY EDMONDS (PNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:EDMONDS
Last Name:BARRINGTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:407 W SOUTH ST # 4298846
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2771
Practice Address - Country:US
Practice Address - Phone:864-429-8846
Practice Address - Fax:864-429-9093
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226627363LP0200X
SC24653363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCK0355019OtherMEDICARE PIN
SCNP7521Medicaid
SCSCK035J577OtherMEDICARE PIN
SCSCK035H895OtherMEDICARE PIN