Provider Demographics
NPI:1518402510
Name:O'KELLY, NATALIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:O'KELLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:FABRIZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-794-7511
Mailing Address - Fax:803-794-7751
Practice Address - Street 1:222 E MEDICAL LN STE 400
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-794-7511
Practice Address - Fax:803-794-7751
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25970363LA2200X
NC5009155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health