Provider Demographics
NPI:1114378304
Name:PRESSLEY, KELLE L
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:L
Last Name:PRESSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLE
Other - Middle Name:L
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1913 BISHOP MADISON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3725
Mailing Address - Country:US
Mailing Address - Phone:704-957-0192
Mailing Address - Fax:
Practice Address - Street 1:1913 BISHOP MADISON LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3725
Practice Address - Country:US
Practice Address - Phone:704-957-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC950074984KMedicaid