Provider Demographics
NPI:1710854757
Name:NERELL, KELLY FOSTER (LPA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:FOSTER
Last Name:NERELL
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPA
Mailing Address - Street 1:3240 BURNT MILL DR STE 9A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2570
Mailing Address - Country:US
Mailing Address - Phone:910-292-6676
Mailing Address - Fax:910-292-4899
Practice Address - Street 1:3240 BURNT MILL DR STE 9A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2570
Practice Address - Country:US
Practice Address - Phone:910-292-6676
Practice Address - Fax:910-292-4899
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPA5114103TC0700X
NC1149122103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool