Provider Demographics
NPI:1265180137
Name:DANIEL, KELLI SUSANNE (APRN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:SUSANNE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-4062
Mailing Address - Country:US
Mailing Address - Phone:706-614-0733
Mailing Address - Fax:
Practice Address - Street 1:503 WINDING WAY
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-4062
Practice Address - Country:US
Practice Address - Phone:706-614-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily