Provider Demographics
NPI:1306846191
Name:MERGY, KELLY FOGARTY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:FOGARTY
Last Name:MERGY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4401
Mailing Address - Country:US
Mailing Address - Phone:910-609-6448
Mailing Address - Fax:910-609-7040
Practice Address - Street 1:1235 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC940034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000948Medicaid
NC7000948Medicaid
NCS70958Medicare UPIN