Provider Demographics
NPI:1205305216
Name:KING, KELLI KRISTIN (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:KRISTIN
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BERMUDA POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1254
Mailing Address - Country:US
Mailing Address - Phone:174-048-5393
Mailing Address - Fax:
Practice Address - Street 1:19 BERMUDA POINTE CIR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1254
Practice Address - Country:US
Practice Address - Phone:740-485-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily