Provider Demographics
NPI:1811549041
Name:KELLY, AMANDA VAUGHAN (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:VAUGHAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SW CARY PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6219
Mailing Address - Country:US
Mailing Address - Phone:919-846-9011
Mailing Address - Fax:844-587-9567
Practice Address - Street 1:1505 SW CARY PKWY STE 309
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-846-9011
Practice Address - Fax:844-587-9567
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily