Provider Demographics
NPI:1710687272
Name:KELLY, DEMEKA LOUISE (RN-BSN)
Entity Type:Individual
Prefix:
First Name:DEMEKA
Middle Name:LOUISE
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HEATHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-8874
Mailing Address - Country:US
Mailing Address - Phone:980-234-2314
Mailing Address - Fax:
Practice Address - Street 1:715 HEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-8874
Practice Address - Country:US
Practice Address - Phone:980-234-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC249340163WC1500X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health