Provider Demographics
NPI:1134749955
Name:BEVANS, KELLIE (APRN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BEVANS
Suffix:
Gender:F
Credentials:APRN, 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 1:5 RED LEAF BND SW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7484
Mailing Address - Country:US
Mailing Address - Phone:678-767-1250
Mailing Address - Fax:
Practice Address - Street 1:650 HENDERSON DR STE 504
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3760
Practice Address - Country:US
Practice Address - Phone:770-607-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine