Provider Demographics
NPI:1912380296
Name:GERUGHTY, KELSEY RAE (APRN)
Entity Type:Individual
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First Name:KELSEY
Middle Name:RAE
Last Name:GERUGHTY
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:9302 MEDICAL PLAZA DRIVE, SUITE C
Practice Address - Street 2:LTC HEALTH SOLUTIONS
Practice Address - City:N. CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:864-751-6424
Practice Address - Fax:864-751-6430
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2017-01-13
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Provider Licenses
StateLicense IDTaxonomies
KY3009576363LA2200X
KY0615012363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health