Provider Demographics
NPI:1659321487
Name:KELLY, MARLENE M (RN)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:M
Other - Last Name:SWEERUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SWCMHC, 215 N. MAGNOLIA ST.
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1946
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:SWCMHC/CLARENDON CMHC, 215 COMMERCE ST.
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-435-2124
Practice Address - Fax:803-435-8113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR26774163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health