Provider Demographics
NPI:1790431492
Name:O'KELLEY, ASHLEY NICOLE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:O'KELLEY
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MISENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-1420
Mailing Address - Country:US
Mailing Address - Phone:336-963-5388
Mailing Address - Fax:
Practice Address - Street 1:170 AMENDMENT AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3073
Practice Address - Country:US
Practice Address - Phone:803-324-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCOKEL-19AEP363L00000X
SC25941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner