Provider Demographics
NPI:1760848105
Name:KELEMEN, KELLYN
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:KELEMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CLEVELAND ST
Mailing Address - Street 2:APT 214
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4431
Mailing Address - Country:US
Mailing Address - Phone:904-994-6019
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSITY RDG
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3635
Practice Address - Country:US
Practice Address - Phone:864-282-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC224000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse