Provider Demographics
NPI:1447245089
Name:KELLEY, MELINDA SUE (APRN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:39 KELLEY LN
Mailing Address - Street 2:
Mailing Address - City:SOCIETY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29593-5284
Mailing Address - Country:US
Mailing Address - Phone:843-378-9199
Mailing Address - Fax:843-334-6583
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:HEALTHCARE PLACE AT BETHUNE
Practice Address - City:BETHUNE
Practice Address - State:SC
Practice Address - Zip Code:29009
Practice Address - Country:US
Practice Address - Phone:843-334-6551
Practice Address - Fax:843-334-6583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN 2434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCR80255Medicare UPIN