Provider Demographics
NPI:1407232978
Name:DOLLINGER, KELLY CHRISTINA (ACNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINA
Last Name:DOLLINGER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:CHRISTINA
Other - Last Name:BURTCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP
Mailing Address - Street 1:PO BOX 751874
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1874
Mailing Address - Country:US
Mailing Address - Phone:843-402-5200
Mailing Address - Fax:
Practice Address - Street 1:2085 HENRY TECKLENBURG DR FL 2
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7710
Practice Address - Country:US
Practice Address - Phone:843-577-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18782363LA2100X, 363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3380Medicaid