Provider Demographics
NPI:1043802259
Name:DENNIS, KELLY RILEY (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RILEY
Last Name:DENNIS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 LULL WATER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4548
Mailing Address - Country:US
Mailing Address - Phone:910-723-7920
Mailing Address - Fax:
Practice Address - Street 1:2310 LULL WATER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-4548
Practice Address - Country:US
Practice Address - Phone:910-988-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily