Provider Demographics
NPI:1568778033
Name:KELLY, KEVIN P
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975A MARKET ST
Mailing Address - Street 2:COMFORT KEEPERS
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1403
Mailing Address - Country:US
Mailing Address - Phone:910-342-9200
Mailing Address - Fax:
Practice Address - Street 1:3975A MARKET ST
Practice Address - Street 2:COMFORT KEEPERS
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1403
Practice Address - Country:US
Practice Address - Phone:910-342-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC31113747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant