Provider Demographics
NPI:1376224469
Name:GURKIN, KELLEN (RNFA-C)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:GURKIN
Suffix:
Gender:F
Credentials:RNFA-C
Other - Prefix:
Other - First Name:KELLEN
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 REDDICKS GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7721
Mailing Address - Country:US
Mailing Address - Phone:252-661-2320
Mailing Address - Fax:
Practice Address - Street 1:628 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3409
Practice Address - Country:US
Practice Address - Phone:252-975-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC20502163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant