Provider Demographics
NPI:1134608094
Name:PELEDGE, KELLY KATHLEEN (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KATHLEEN
Last Name:PELEDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KATHLEEN
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2416 CAPSTONE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2795
Mailing Address - Country:US
Mailing Address - Phone:706-327-1281
Mailing Address - Fax:706-327-1159
Practice Address - Street 1:2416 CAPSTONE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2795
Practice Address - Country:US
Practice Address - Phone:706-327-1281
Practice Address - Fax:706-576-9714
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236326163W00000X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics