Provider Demographics
NPI:1518733724
Name:TREFFINGER, KELLY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:TREFFINGER
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 1:2986 OLD BERWICK ST SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-6139
Mailing Address - Country:US
Mailing Address - Phone:910-478-7481
Mailing Address - Fax:
Practice Address - Street 1:2986 OLD BERWICK ST SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-6139
Practice Address - Country:US
Practice Address - Phone:910-478-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCTREF-3B9PX363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner